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.
Health system; health statistics; primary health care; Saudi Arabia
Induced Abortion for social reasons is spreading all over the world. It is estimated that globally 50 million unborn babies are killed annually, resulting in the deaths of 200,000 pregnant women and the suffering of millions. The complications of illegal abortion are very serious. Abortion is still used in many countries as a means of family planning. The medical reasons for abortion are limited and con-sti-tute a small proportion of all abortion cases. This paper discusses the different views on abortion, its history, its evolution over time, and the present legal circumstances. The emphasis is on the situation in Islamic countries and the effect of Islamic Fatwas on abortion.
Induced abortion; illegal abortion; family planning; Islam
Assess the attitude and practice of Primary Health Care (PHC) physicians in Aseer region, their educational needs and recommendations to establish a continuing medical education program (CMEP) to address these needs.
This study was carried out during the first half of 1999 in Aseer region, Saudi Arabia. A self-administered questionnaire was distributed to all PHC physicians in Aseer region. The questionnaire explored socio-demographic characteristics, scientific background, the attitude towards CME, the current method for medical updating, the barriers to CME, and the topics requested for a future CMEP.
There were a total of 383 PHC physicians in Aseer region, 86% of whom responded to this questionnaire. Of these 76.1% were Arabs, 91.2% were married, 26.3% had post-graduate qualifications and 68.6% had had no experience in the PHC field prior to arriving in Saudi Arabia. Most respondents showed a positive attitude toward CME. Nearly two-thirds (64.4%) had adequate time for CME, 86.7% allocated time for CME, and 64.4% were ready to participate as tutors in CMEP. Suggestions were given by 49.6% for establishing a CMEP in the region. The most popular methods practiced for CME were reading medical journals (79.8%) and medical textbooks (53.8%), and attending training courses (39.6%). The medical subjects that were identified as needed were emergency medicine (24.5%), pediatrics (20.8%), internal medicine (20%), and obstetrics/ gynecology (18.7%). However, 75.2% also indicated that computer literacy was a practice requirement, 57.7 and 54.1% thought designing diabetes and hypertension management programs were vital, and 41.7% said learning how to design a PHCC action plan was essential.
PHC physicians in Aseer region had a positive attitude towards selective CMEP. They needed CMEP but felt its content should be in line with their practice needs.
Attitude assessment; practice needs; CME; primary care physicians; Aseer region
Community pharmacists in Saudi Arabia very often make decisions that affect patient outcome. Previous studies have indicated that they have access to limited sources of information. Therefore, structured continuing pharmaceutical education (CPE) is necessary to improve their standards and attitudes.
Identify the most important topics for CPE as well as the most significant barriers to conducting CPE successfully.
A questionnaire was distributed to 120 pharmacists working in 88 community pharmacies in the Eastern Province of Saudi Arabia. The survey contained five sections: general background, topics for CPE that could be of great interest to community pharmacists, possible obstacles to attending CPE, method of instruction, and the most suitable time and day of the week for conducting CPE.
One hundred and five (87.5%) pharmacists answered the survey questionnaire. The rank order of the five most selected topics for CPE were: drug interaction (81.9%), drug use during pregnancy (77.1%), use of anti-microbial agents (62.5%), pharmaceutical ethics (53.3%), geriatric and pediatric pharmacology (45.7%). For pharmacists, the most important obstacles to attending CPE were lack of time (96.2%), distance from practice (74.2%), and lack of programs or information about these programs (54.3%). Interestingly, 47.6% of the pharmacists recommended credentialing CPE and stated that knowing the lecturer was not considered an important factor.
Conclusion and recommendations:
The findings of this study demonstrated that pharmacists are willing to participate in CPE programs. However, the working conditions of pharmacists would be a major barrier to their attendance. Therefore, improvement of the working conditions of community pharmacists, development of credited CPE programs in each region, as well as improving communication between the Saudi Pharmaceutical Association and community pharmacists are highly recommended.
Continuing pharmaceutical education; pharmaceutical care; community pharmacists; community pharmacies; Saudi Arabia
Determine the sero-prevalence of rift valley fever (RVF) among slaughterhouse personnel in Makkah during Hajj and define personal and work place correlates.
Materials and methods:
A sample of 294 participants were chosen randomly from slaughterhouse personnel in Makkah during Hajj 1419 (1999). Data were collected through personal interviews using a pre-designed questionnaire consisting of personal and work place variables, e.g. age, nationality, type and hours of work. A blood sample was collected from each participant and tested by enzyme immuno-assay for IgG antibody using killed antigen for rift valley virus.
Of the total sample, 17% was seropositive for RVF. The rate of infection varied with country of origin: Syria (10.6%), Egypt (21.2%), Bangladesh (22.6%), Mali (47.1%) and Niger (50%). The number of animals slaughtered per hour and daily hours of work were significantly associated with prevalence of RVF (p<0.05).Multivariate logistic regression analysis showed that nationality and daily hours of work predicted 84.1% of the occurrence of RVF.
Sero-surveys should be done among slaughterhouse personnel in Saudi Arabia and other countries particularly in countries known to be free from RVF, e.g. Syria and Bangladesh to assess the situation of RVF. The importation of animals from endemic areas should be banned.
Rift valley fever; slaughterhouses; Hajj
Assessment of patient satisfaction offers a way of optimizing health status and prevents waste of medical resources. The direct measurement of patient satisfaction is a new phenomenon in Kuwait.
Assess patient satisfaction with respect to primary health care services and study any patterns of association of sociodemographic variables on the patient satisfaction level.
The sample consisted of 301 patients selected systematically from five primary health care centers to represent various geographic areas in Kuwait City. Just over 56% of the sample were females, 59% were married, the great majority (70.4%) were government employees, more than 60% had a monthly income of less than 900 KD, more than 54% were intermediate and high secondary school graduates, and 37% were university graduates or had advanced degrees. The data was collected by personal interview using structured questionnaire.
The overall mean satisfaction was 3.1 points out of five (62%). The mean satisfaction scores were 3.64, 3.29, 3.08, 3.05, 2.21 for laboratory, pharmacy, radiology, dental and physician services, respectively. The highest mean score for physician services was obtained for communication skills (2.23); for pharmacy services, the availability of medicine (4.01); for laboratory services, the availability of lab materials (3.73); for radiology services, the waiting time for x-ray (3.60); and for dental services, the adequacy of dentists (3.27). The results indicated that gender, income, marital status and occupation were the most consistent demographic predictors of satisfaction, with females, those with lower income, lower education levels and the unemployed having higher mean satisfaction scores.
There is a need for corrective intervention in some service areas and for an educational program to inform patients of the objectives and limitations of primary health services.
Primary care; satisfaction; sociodemographics; Kuwait
Identify the types and prevalence of intestinal parasites among food handlers, and test the effectiveness of the current pre-employment screening policy.
A cross sectional survey was carried out in the catchment areas of seven primary health care centres (PHCCs) to represent various sections of Riyadh city. A total of 700 food handlers working in restaurants were randomly selected from the study area. All study subjects were asked to complete a data collection form and to bring a fresh stool specimen on the specified day to the designated PHCC.
About 66% of the selected subjects complied in bringing fresh stool specimens. Fifty nine (12.8%) of the specimens were positive for parasites. There was a significant association between the food handler's nationality and the likelihood of a positive specimen result, being highest among the Bangladeshis (20.2%) and Indians (18.5%) and the lowest among the Arabs (3.4%) and the Turks (10%). The commonest intestinal parasites isolated were Giardia lamblia (33.8%), followed by Enterobius vermicularis (27.4%). The current screening policy does not seem effective, as there was an absence of significant association between holding a valid PEHC and the test result, with 81% of the positive results from persons holding valid pre-employment health certificates (PEHCs).
Though it is obligatory for food handlers to hold a PEHC in Saudi Arabia, the prevalence of intestinal parasites remains high. Possible solutions include health education on hygiene, more frequent stool tests, and assessment of the current annual screening procedure.
Intestinal parasites; health education; foodhandlers; Saudi Arabia
Assess knowledge and attitude of Saudi females towards screening mammography.
Material and Methods:
A sample of four hundred Saudi females were interviewed using a structured questionnaire.
Positive family history of breast cancer was the most significant factor that was positively associated with individual knowledge and attitude towards screening mammography (p<0.00001). There was no significant association with the level of education. Poor knowledge and attitude were observed among 41.8% of all participants, especially in relation to not having mammography done or not wishing to have it done. There were 51 (12.8%) participants who had not had mammography done, but wished to have it, 25 (6.3%) participants who were undecided about having mammography done in the future, while 67 (16.8%) wished to have it done every one to two years.
This study showed that there has been deficient knowledge and attitude towards screening mammography even among the highly educated, and stressed the need for health education on the importance of screening.
Screening; mammography; breast cancer; Saudi Arabia
Obtain the undergraduate medical students’ evaluation of an objective structured clinical examination (OSCE) formed by two stations in neurology.
The fifth-year medical students taking the neurology course at King Faisal University during the first rotation of academic year 1420-1421H (2000-2001G) made the evaluation. The time for each station was seven minutes. After finishing the examination, each student completed a six-item questionnaire on coverage, question clarity, time, patients, educational usefulness and organization of the examination with yes, no or don’t know responses.
A total of 48 students (30 males and 18 females) took the examination. The average time to complete the examination for a group of 16 students was 2 hours. The responses were positive for clarity of questions and organization of the examination 41(85%), and allotted time 36(75%). Thirty-two students (67%) found the structured examination a useful educational experience. About half the students expressed their concern about the coverage of taught material and the number of patients seen in the examination as representative of those seen during the course, and 11 students (23%) requested more time.
The students’ response to the use of the structured clinical examination as an objective tool for evaluation of clinical skills in neurology was favorable and comparable to reports from other parts of the world. Improvement is required in the number of patients, coverage and allotted time to optimize outcome by improving content validity and reducing stress on participating patients.
Neurology; undergraduate; medical education; OSCE; Saudi Arabia
To determine the biochemical constitution of homemade fluids and assess their acceptability and efficacy for the management of acute diarrhea in Sudanese children.
Material and Methods:
This is a cross-sectional study of 150 children selected randomly. The fluids studied were 36 samples of sorghum-based solutions (nasha) and 10 samples of rice water. Samples were randomly collected from households and analyzed to determine the pH, carbohydrates, proteins, fat, crude fiber, ash and electrolytes (Na+, K+ and Cl-).
In addition to being very useful for rehydration, the two fluids were found to contain considerable amounts of nutrients. The sodium and chloride contents of homemade fluids were found to be much lower than those of the WHO/UNICEF ORS (oral rehydration solution). These electrolytes can be adjusted by adding table salt (3-3.5 g NaCl to one litre of sorghum-based solution and 2.3-2.6 g NaCl to one liter of rice water) to bring them to concentration comparable to that of the standard ORS.
Homemade solutions can be modified by adding table salt to bring them to the standard ORS and can be used successfully to prevent dehydration. This will solve the problem of the availability of ORS and reduce morbidity and mortality from diarrhea.
Acute diarrhea; dehydration; sorghum gruel; rice-water; ORS; Sudan
To describe correlates of various modes of presentation and identify some surrogates of poor outcome of children less than 5 years with Acute Otitis Media (AOM).
Patients and Methods:
This is a cross-sectional survey conducted at 11 primary health care centers in Riyadh city over 3 month period. A total of 140 children, each less than 5 years of age and presenting with a new episode of AOM were enrolled. Twenty-eight family physicians participated in the study. Each physician made the diagnosis of AOM based on history and clinical examination of the tympanic membranes (TM) using an otosocope. Poor outcome was defined as children presenting with otorrhea.
The majority of children presented with fever (62%), URTI (58%) and earache (54%). Presence of URTI, irritability, or sleeplessness were positively associated with redness and dullness of TM (p<0.05). Thumb sucking reduced the risk of bulging (OR = 0.29, 95% CI: 0.07-0.94). Children of illiterate fathers were more likely to present with otorrhea (X2 = 4.66, p< 0.05). Bottle feeding increased the risk of otorrhea by two fold (OR = 2.26, 95% CI:1.01-5.05).
Children with AOM presenting as URTI, irritability or sleeplessness will showed redness and dullness of the TM as clinical signs of the disease. Thumb sucking was found to be protective from bulging of the TM. Having an illiterate father and being bottle fed were found to be surrogates of otorrhea .
Acute otitis media; presentation; poor outcome; risk factors; Saudi Arabia
The objective of this cross-sectional study was to determine the mean period of school absenteeism (MPSA) among Questionnaire Diagnosed Asthmatic (QDA) Saudi schoolboys of Al-Khobar city and the factors associated with it.
The methodology of this cross-sectional study included the distribution of a self-administered questionnaire, which was completed by the parents of 1482 schoolboys who satisfied the selection criteria of the study.
The prevalence rate of QDA was 9.5% (141/1482). MPSA among Questionnaire Diagnosed Asthmatic Boys (QDAs) was 13.6 ± 3.4 days compared to 3.7 ± 2.2 days among non-QDA boys (non-QDAs). Among QDAs, it was associated significantly and positively with those who were younger, with a decreasing level of socioeconomic class, history of pets at home, presence of a current smoker in the family (father or both parents), visit to a hospital emergency room, and admission to hospital. It was significantly and negatively associated with concomitant use of prophylactic medication(s), including those used appropriately. QDAs from middle and lower socioeconomic classes used less prophylactic medication(s) but had had more visits to an emergency room and had admissions to hospital. The multiple linear regression equation for the total period of school absenteeism (TPSA) during the current academic year was generated.
QDAs have higher MPSA compared to their non-asthmatic classmates. The impact of this disease increases particularly among QDAs belonging to lower socioeconomic families.
Childhood asthma; School absence; Saudi Arabia
Identify the possible risk factors in our community that may influence having a disabled child, and identify the rehabilitation services available to disabled children.
Data were collected from six rehabilitation institutes for auditory, visual and mental disabilities in Jeddah City during April 1999. Complete data available on sociodemographic and medical risk factors were extracted from the institutes’ files. Personal interviews with the disabled were conducted to confirm information on the services offered to them.
Certain modifiable risk factors affecting child health, such as early and late marriages and childbearing, illiteracy, unemployment, high parity and consanguineous marriages still exist in our community. Occupational hazards were also detected among military workers and working women. Disabilities related to perinatal health with antenatal, natal and postnatal components were also observed. According to resources available, various rehabilitation services are offered to disabled children.
The need for intervention in two areas of health is crucial. The first is the prevention of future disabilities through continuous research, modification of unfavorable habits and the strengthening of the quality of perinatal care. The second is the improvement of rehabilitation services in order to raise the quality of life of the handicapped.
Childhood disability; handicapped; risk factors; consanguineous marriage; perinatal care; Saudi Arabia
Abdominal pain is perhaps the most challenging of all the presenting complaints in the emergency department. It is estimated that it accounts for 5%-10% of all visits. Causes of abdominal pain range from the inconsequential to the life threatening. In addition, it nearly always poses a greater degree of diagnostic uncertainty in women of child-bearing age as compared to males. Such difficulties become more pronounced in pregnant women where the unwritten policy seems to be: If she is pregnant blame the pregnancy. This policy is justified by the favorable clinical outcomes. However, in a small but significant number of patients, this policy has the potential of creating delays and increasing the risk of unwarranted complications. Delays in management may lead to emotional trauma, loss to the society, and the potential for serious liability.
This review was undertaken at King Fahd hospital of the University, Eastern Province of Saudi Arabia, with a literature search covering a period of over twenty years. It mainly highlights the diagnostic difficulties in young women presenting with acute onset abdominal pain, and possible solutions.
It also suggests a policy which includes a careful clinical approach with liberal consults between the surgeon and the gynecologist reinforced by a judicious use of the available diagnostic aids leading to potentially favorable outcomes.
Pregnancy; acute abdomen; acute appendicitis; intestinal obstruction
The introduction of the World Wide Web has revolutionized the applications of the computer and the Internet in the medical field. The Web provides an easy and cost-effective way of retrieving medical information and a more flexible way of communicating with patients and colleagues. Family practice is a specialty in which care is given to persons as individuals and members of families regardless of their age, gender or specific problems. To provide quality family practice, a family physician should be a good communicator, a critical thinker, a resource and information manager, a life-long learner, a care giver and a community advocate. Providing such high quality care requires that family practice be an information-sensitive specialty. However, the expansion of the new electronic resources on the Internet and the Web poses a real challenge to the family physician. Family physician in Saudi Arabia need to have basic skills and knowledge for easily retrieving and finding reliable Internet information for his professional development and the care of his patients. This article addresses the Web applications for family physicians in Saudi Arabia, giving examples of the most important Websites.
Internet; World Wide Web; Family Practice/Medicine; Saudi Arabia
Sildenafil (Viagra) is the most effective oral therapy currently available for erectile dysfunction. Patients should be given clear instructions regarding the use of sildenafil. The most common side effects include flushing, headaches, dyspepsia, and transient visual changes. In combination with nitrates, it can and has caused fatal hypotension. It should not be prescribed to patients on nitrates. Additionally, nitrates should not be administered to anyone who has recently ingested sildenafil. Synergetic blood pressure lowering has not been observed when sildenafil was used with other classes of antihypertensives. Sildenafil is not offered to patients with low cardiac output states, those on intensive regimens to prevent heart failure or those with acute coronary ischemia.
Sildenafil; erectile dysfunction; heart failure
The primary aim of the study was to calculate the prevalence of some of the health risk associated behavior like insufficient amount of exercise, cigarette smoking, alcohol intake, illicit drug use, driving below age of 18, and illegal sexual practices among the Saudi adolescents in Riyadh city. The second was to study the association between cigarette smoking and the above behaviors.
Material and Methods:
It was a cross-sectional survey with 1473 Saudi adolescents, 852 males (57.8%) and 621 females (42.2%) aged 11 to 21 years attending the selected 10 Primary Health Care Centers (PHCCs) were invited to complete a 23-item questionnaire. Part of the questionnaire was used to measure the frequency of some adolescent behavior. These questionnaires were collected within a period of one month from 15 May to 15 June 1998. The PHCCs were selected randomly in Riyadh city.
The prevalence of cigarette smoking was 12.7%, males smoking more than females (19.0% vs. 4.0%); male smokers exercised significantly less than nonsmokers (p<0.025). Only 4.5% of the sample reported alcohol use, 6.4% reported illicit drug use, and 8.0% reported illegal sexual practice. There is a statistically significant association between smoking and other risk behavior. It was found that 41.1% of males below the age of 18 drive a car, and 45.1% of the study sample that drive had a car accident.
The prevalence of illicit drug use, alcohol intake, and illegal sex in Riyadh city is much less than in the west. Cigarette smoking is an antecedent to more negative behavior. Antismoking programs including the prevention of the sale and use of cigarettes in public places are needed to decrease its prevalence. The application of firm traffic laws is also essential.
Saudi adolescents; primary health care centers; behaviours
Health Education (HE) is vital to each of the seven other central ele-ments of Public Health Care (PHC). HE must be carefully planned and implemented. A crucial part of HE is planning, production and placement of effective HE posters.
Assess the quality of health education posters in Al-Khobar PHC centers.
A cross-sectional study of a sample of 138 HE posters in three PHC centers in Al-Khobar was conducted. The quality of posters in relation to set criteria was measured using a data sheet and scoring system developed by the investigator.
The health education subjects displayed were among the common health problems in Saudi Arabia in 134 (97.1 %) of the posters.More than one-third (34.8%) had been displayed for more than one year. In 74 (53.6%) of the posters, the source of scientific information was unknown. The assessment showed that 109 (79%) posters were of optimal quality.
The study showed that the health education posters in PHC centers in Al-Khobar were relatively satisfactory, though they did not fulfill some of the required criteria. Health education posters should be included in the assessment of health education programs in primary health care centers.
Health education; posters; assessment; primary health care
Asthma is a common health problem whose prevalence in Saudi Arabia has risen over the last few decades. Brick factories in the city of Bahrah have exacerbated the problem, and increasing numbers of asthma cases are attending local primary health care centers.
Determine the risk factors of asthma in Bahrah.
Materials and Methods:
The study was comprised of 110 cases of bronchial asthma resident in Bahrah who were diagnosed by the treating physicians and 110 healthy controls matched in age and sex. A questionnaire was completed from cases and controls, consisting of data regarding personal, familial, indoor and outdoor environmental factors that may be potential risk factors to asthma. Bivariate and multivariate logistic regression analyses were done to assess risk factors.
The mean ages of cases and controls were 22.4 (± 16.7) and 22.8 (± 16.1) years, respectively. Each group consisted of 64 males (58%) and 46 (42%) females. There was a significant association between distance from houses to brick factories and bronchial asthma (Chi square for linear trend = 26.6, p<0.001). Multivariate logistic regression analysis showed that living within one kilometer of a brick factory (OR=5.1, CI=2.33-11.16), family history (OR=4.6, CI=2.16-9.78), allergic rhinitis (OR=3.39, CI=1.49-7.69), skin atopy (OR=4.6, CI=1.53-13.87) and recurrent respiratory tract infections (OR=4.1, CI=1.79-9.22) were independent risk factors for asthma in Bahrah.
Conclusions and recommendations:
Brick factories, family history and history of rhinitis, skin atopy, or recurrent respiratory tract infections are risk factors of bronchial asthma. An in-depth study to asses air pollution in Bahrah is recom-mended. People are advised not to live near brick factories.
Bronchial asthma; brick factories; air pollution; allergic diseases
Recognize the patterns and the cost of the drugs dispensed to summer visitors who attended Primary Health Care Centers (PHCCs) in Aseer region.
This study was conducted in Aseer region during the summer of 1998. The investigators designed and distributed special forms on which were blanks for names, age, sex, diagnosis and drugs that were prescribed for summer visitors who attended PHCCs in Aseer region. At the end of season, all the forms were collected and analyzed manually by well-trained nurses and assistant pharmacists. The cost of the drugs was calculated according to the price list provided by the Medical Supply Department.
A total of 96327 forms were evaluated. These represented 25% of the total number of prescriptions issued by PHCC physicians during the summer season. The total cost of the dispensed drugs was estimated as 190533 SR (50808$). About 20% of what was dispensed was for summer visitors who had utilized the PHCC services in Aseer region. Antibiotics and painkillers cost 42% and 21% of the total cost respectively.
This study showed that the cost of drugs for summer visitors in Aseer region was 20.5% of the total drug cost. This additional cost should be considered in planning the drug budget.
Cost; primary health care centers; summer visitors; Aseer region
Toxoplasma gondii is an obligate intracellular protozoa of worldwide distribution. In immunocompetent adults, it is usually the cause of asymptomatic infection. However, infection during pregnancy poses a special risk because of the teratogenic effect of toxoplasma.
Determine the sero-prevalence of toxoplasmosis in pregnant women and newborn infants in King Fahd Hospital of the University, Al-Khobar, Eastern Province.
In this hospital-based study, sera from 175 pregnant females were screened for toxoplasma IgG and IgM.
Results and Conclusion:
A very low number (N=1/175, 0.57%) of pregnant mothers seroconverted during pregnancy, although many (N=69/175, 39.4%) were recorded with inactive toxoplasmosis during pregnancy. Delivery was normal in all cases except for a small number (N=1/175, 0.57%) of newborns (as recorded from cord blood) who were positive for toxoplasmosis.
Toxoplasma; pregnant women