Use of complementary and alternative medicine for children: a parents' perspective.

OBJECTIVES: The present study aims to detect the frequency and types of complementary and alternative medicine (CAM) therapies used for children and to explore parental motivating factors for using CAM for their children in Riyadh, Saudi Arabia. PARTICIPANTS AND METHODS: This is a cross-sectional study that involved 462 families selected through a multistage cluster-sampling technique covering Riyadh region, Saudi Arabia. The sample was selected from 40 clusters, distributed proportionally according to the size of the population in the catchment area of primary health care centres (PHCCs). A structured questionnaire that contains items fulfilling the research objectives was used to collect data by research assistants. RESULTS: The study included 926 parents, comprising 351 fathers and 575 mothers; 37.3% of them reported the use of CAM for their children including reciting the Quran, honey and Ferula asafoetida (26.1%, 21.5% and 18.8%, respectively). CAM was used six times higher for children of parents using CAM for themselves than children of parents who did not use CAM themselves (odds ratio (OR)=6.03, 3.9-9.37). Multivariate logistic regression showed that parental use of CAM (OR=3.0, 2.2-4.0), keeping CAM remedies at home (OR=2.3, 1.8-3.1), perceived success of CAM in practice (OR=1.8, 1.3-2.4) and preference of use of natural materials (OR=1.7, 1.2-2.5) were independent predictors of use of CAM for children. CONCLUSIONS: In this study, around one-third of the parents used CAM for their children. Quran (Muslims' holy book) was the most common CAM type used for children. Parents' use of CAM for themselves is the most important predictor of its use for children. An in-depth study to investigate CAM use for specific diseases in children is recommended.

Outbreak of Bacille Calmette-Guérin-related lymphadenitis in Saudi children at a university hospital after a change in the strain of vaccine.

BACKGROUND AND OBJECTIVES: Bacille Calmette-Guérin (BCG) vaccination is part of the expanded program of vaccination in Saudi Arabia. Lymphadenitis is the most common complication of the BCG vaccine. We observed an increase in the rate of BCG lymphadenitis that coincided with the introduction of a new strain of BCG vaccine. The aim of this study was to determine the incidence and the possible causes of BCG lymphadenitis at a university hospital in Riyadh, Saudi Arabia. DESIGN AND SETTING: Retrospective chart review and prospective follow up of infants who received BCG vaccine. METHODS: We studied all infants presenting with suppurative or nonsuppurative adenopathy with nodes age;2 cm seen at the infectious diseases clinic at KKUH. The study duration was divided into two periods. The first period reviewed infants who received different BCG vaccine strains between January 2002 and December 2007. The second study period was conducted after close evaluation of the BCG administration technique of the vaccinating staff and reviewed infants who received the BCG SSI Danish strain 1331 between January 2008 and December 2010. RESULTS: During the study period from January 2002 to December 2007, 19 402 infants received four different BCG vaccine strains. Eight infants developed BCG lymphadenitis, and all were associated with the BCG SSI vaccine. The incidence rate in 2007 was 1.96 per 1000. In the second period, 66 of 9921 infants who received the BCG SSI vaccine developed BCG lymphadenitis between January 2008 and December 2010. The incidence rate was 10.14 per 1000 in 2010. CONCLUSION: We conclude that receipt of the BCG SSI vaccine might have contributed to the increased incidence of lymphadenitis in these children. Hence, caution should be exercised in switching from one vaccine to another, as is often done in developing countries.

Pattern of injuries among children and adolescents in Riyadh, Saudi Arabia: a household survey.

OBJECTIVES: To determine the incidence and pattern of injuries among children and adolescents <18 years old in Riyadh city and to identify associated factors. MATERIAL AND METHODS: A cross sectional household survey included children and adolescents <18 years. A two-stage cluster sample was used to recruit the participants from thirty clusters each consisted OF 23 households. A questionnaire was used for data collection by interview. RESULTS: The study included 1650 children and adolescents. Of them, 22.2% reported having had injuries in the previous 12 months. The most common injuries were falls (40.4%), Road Traffic Accidents (RTA) (15%), food intoxication (8.8%). Males were more affected by injuries than females (26% vs. 18%). Males living near playgrounds or public gardens, playing in the street are independent risk factors for occurrence of both falls and RTA injuries. RECOMMENDATIONS: school safety education and environmental modification should be applied in Riyadh.

Controlling Blinding Trachoma in the Egyptian Delta: Integrating Clinical, Epidemiological and Anthropological Understandings.

Trachoma is a leading cause of preventable blindness in the world. The disease is hyperendemic in rural Egypt, where more than 75% of children show signs of having had at least one episode of infectious trachoma during the first year of life. Earlier anthropological and epidemiological observations suggested that trachoma prevalence would decrease if children had their faces washed with soap and water at least once each day. We conducted a community-based intervention to increase face washing in order to control trachoma. In this paper we describe the overall design of this intervention trial and discuss how we integrated anthropological methods and ethnographic data into the design of this successful multi-disciplinary, cross-cultural project to prevent trachoma.

Dermatology practice in primary health care services: where do we stand in the Middle East?

BACKGROUND: There has been a distinct expansion of the primary health care services in the Middle East over the past two decades. As a consequence, the exposure of primary care physicians (PCPs) to skin disorders has increased. However, information is lacking regarding the level of proficiency of PCPs in this field. OBJECTIVE: The purpose of our study is to assess the ability of the primary care physicians, with or without training in dermatology, to identify, diagnose and manage skin disorders. MATERIAL AND METHODS: Physicians at university-hospital primary-care clinics were asked to answer a multiple-choice questionnaire regarding various dermatoses. These were grouped into: common, infrequent and rare. Questions included identification of the correct description of the skin lesion, diagnosis, treatment and the desirability of referral. Demographic characteristics of the physicians were also assessed. RESULTS: Nineteen PCPs were included. The eight PCPs who had had specific training in dermatology showed performance superior to that of the PCPs who did not (P = 0.04). Not surprisingly, PCPs were able to make the correct diagnosis more frequently for the common dermatoses than for the infrequent or rare dermatoses (P = 0.001). On the other hand, when asked to recognize a correct description of the skin lesion, the PCPs were most often correct with rare dermatoses, and least often correct with common dermatoses (P = 0.04). CONCLUSION: PCPs with a short period of specific clinical training in dermatology perform better in identifying, diagnosing and managing skin disorders than those without. Such training for PCPs should be considered to provide more effective delivery of health care.

La dermatología en los servicios de atenciónprimaria: situación en Oriente Medio / Dematology practice in primary health care services: where do we stand in the Middle East

Antecedentes: Durante las dos últimas décadas se ha producido una expansión clara de los servicios de atención primaria en Oriente Medio. Como consecuencia, ha aumentado el número de consultas por trastornos de la piel realizadas por los médicos de atención primaria (MAP). Sin embargo, carecemos de información respecto al nivel de conocimientos de los MAP en este campo. Objetivo: El objetivo de nuestro estudio es valorar la capacidad de los médicos de atención primaria con o sin formación en dermatología para identificar, diagnosticar y tratar los trastornos de la piel. Materiales y métodos: Se pidió a los médicos de las clínicas de atención primaria del hospital de la universidad que contestaran a un cuestionario con múltiples respuestas sobre varias dermatosis. Éstas se agruparon en: comunes, infrecuentes y raras. Las cuestiones incluían la identificación de la descripción correcta de la lesión de la piel, diagnóstico, tratamiento y deseo de remisión. También se valoraron las características demográficas de los médicos. Resultados: Participaron 19 MAP. Los 8 MAP que habían tenido formación específica sobre dermatología tuvieron mejor rendimiento que los MAP que no habían recibido esta formación (p=0,04). Los MAP fueron capaces de hacer un diagnóstico correcto más frecuentemente para las dermatosis comunes que para las dermatosis no frecuentes o raras (p=0,001). Por otra parte, cuando se les pidió que reconocieran una descripción correcta de la lesión de la piel, los MAP hicieron una descripción más correcta de las dermatosis raras y menos de las comunes (p=0,04).Conclusión: Los MAP con un corto período de formación clínica específica de dermatología son mejores en la identificación, diagnóstico y tratamiento de los trastornos de la piel que aquellos que no tienen esta formación. Debería considerarse la posibilidad de dar dicha formación a los MAP para proporcionar una atención sanitaria más eficaz (AU)

Compliance with antituberculosis drugs among tuberculosis patients in Alexandria, Egypt

Tuberculosis is an important reemerging disease with increasing global morbidity and mortality. Tuberculosis control is hindered by patient noncompliance with treatment regimens. To study compliance to antituberculosis drug regimens, 172 patients diagnosed with tuberculosis during the first three months of 1995 were investigated. The patients were interviewed at their homes during July and August 1995. More than one-third [34.9%] of the patients were not adhering to the antituberculosis drug regimen. Factors increasing drug compliance included: disease symptoms, knowledge about the disease, family history of tuberculosis and hospitalization. More information about the disease and the importance of compliance should be provided to tuberculosis patients at the time of diagnosis and initiation of therapy. Supervision of drug administration by health care personnel is stressed