Elijah A. Bamgboye

Overweight and obesity in Saudi Arabian adult population, role of socio-demographic variables

The objectives of this Community-based National Epidemiological Household Survey, conducted between 1990–1993, were to estimate the prevalence of overweight and obesity in Saudi Arabia and to examine its association with the socio-demographic characteristics of the adult population. A sample of Saudis 20 years and over was selected using a multistage stratified cluster sampling technique with probability proportionate to size. The selected subjects were requested to visit primary health care centers in their localities. Physicians in these clinics took measurements of heights and weights and collected other relevant data. Obesity was measured by the Body Mass Index, using the Quetelet Index. The results showed the sample of 10,651 subjects of which 50.8% were males, had a mean age of 35.8 years (SD = 14.27 years). The prevalence of overweight was 31.2% (95% confidence interval: 30.3%, 32.1%); 33.1% for males and 29.4% for females. For obesity, the overall prevalence was 22.1%; males 17.8% and females 26.6%. The study design suggested that these estimates could be closer to the true values. The multiple logistic regression analysis showed that age, residential area, region, income, gender, and education are statistically significant predictors of obesity. The prevalence of obesity was higher in females than males, lower in subjects living in rural areas with traditional lifestyles than those in more urbanized environments, and increased with increasing age. The observed prevalence and pattern of overweight and obesity with age and gender is similar to those observed in the Arab community and some Western nations. There is a need for increased physical activity and better nutrition education programs to reduce the extent of obesity and to pre-vent the serious health consequences, especially, in the middle age group.

Validity of the Arabic version of the eating attitude test

OBJECTIVES To assess the validity of the Eating Attitude Test (EAT-26) in Arabic as a screening instrument in nonclinical populations. METHODS A representative sample of Grade 7-12 female students in Riyadh, Saudi Arabia, was selected randomly but proportional to various social classes. The girls were independently assessed by the EAT-26 and a structured clinical interview. RESULTS One hundred twenty-nine subjects were included. Twenty-five were identified by EAT-26 as having abnormal eating attitudes. One case was identified as anorexia nervosa by the interview and no cases of bulimia were found. DISCUSSION EAT-26 was found to be highly sensitive and reasonably specific. Like some other studies in non-Western populations, it yielded a high false positive rate and a low positive predictive value. Because of its low cost and practicality, EAT-26 might be a useful tool in screening large populations for eating disorders.

Multivariate determinants of the need for postoperative ventilation in myasthenia gravis

PurposeFollowing transsternal thymectomy, up to 50% of patients may require postoperative ventilation. The aim of this study was to identify the variables most useful in predicting the myasthenic patient who needs postoperative mechanical ventilation.MethodsWe applied multivariate discriminant analysis to preoperative physical, historical, laboratory and intraoperative data of 51 myasthenic patients who underwent transcervical-transsternal thymectomy to select those variables most useful in predicting the postoperative need for mechanical ventilation. The receiver operating characteristic (ROC) curve was also used to describe the discrimination abilities and to explore the trade-offs between sensitivity and specificity of the model.ResultsDiscriminant analysis identified seven risk factors that correlated with the need for postoperative ventilation: FVC, FEF25–75%, MEF50% and their percentages of the predicted values, as well as, sex. The model correctly predicted the actual ventilatory outcome in 88.2% of patients. The area under the ROC curve verified that our model correctly predicted the actual ventilatory outcome with a probability of 88.2%.ConclusionsThis model can be used for predicting the need for postoperative mechanical ventilation in myasthenia gravis patients.RésuméObjectifAprès une thymectomie transternale, jusqu’à 50% des patients peuvent avoir besoin de ventilation postopératoire. L’objectif de cette étude était d’identifier les variables les plus utiles pour prédire le besoin de ventilation mécanique postopératoire chez le myasthénique.MéthodesL’analyse discriminante multifactorielle a été appliquée à l’examen physique préopératoire, à l’anamnèse, au laboratoire et aux données peropératoires de 51 myasthéniques qui ont subi une thymectomie transcervicotransternale dans le but de choisir les variables les plus utiles pour prédire le besoin postopératoire de ventilation mécanique. La courbe ROC (receiver operating characteristic) a aussi été utilisée pour décrire les capacités de discrimination et pour explorer les échanges entre la sensibilité et la spécificité du modèle.RésultatsL’analyse discriminante a identifié sept facteurs de risque qui corrélaient avec le besoin de ventilation postopératoire: CVF, FEF25–75%, FEM50% et leur pourcentage des valeurs prédites, ainsi que le sexe. Le modèle a prédit le résultat ventilatoire actuel chez 88,2% des patients. La surface sous la courbe a prédit correctement le résultat ventilatoire actuel avec un probabilité de 88,2%.ConclusionOn peut utiliser ce modèle pour prédire le besoin de ventilation mécanique postopératoire chez des patients souffrant de myasthénie grave.

Predictors of smoking among male junior secondary school students in Riyadh, Saudi Arabia.

OBJECTIVE: To determine the prevalence and determinants of cigarette smoking among intermediate (junior secondary) schoolboys in Riyadh, Saudi Arabia. PARTICIPANTS: A sample of 1382 students (ages 12-19 years) in 45 classes randomly selected from 15 schools, using a two-stage stratified cluster sampling scheme. DESIGN: Students in the selected classes were requested to complete an anonymous questionnaire, under the supervision of trained interviewers. Univariate and multivariate statistical analyses of potential risk factors were performed. SETTING: Intermediate schools in Riyadh, Saudi Arabia. MAIN OUTCOME MEASURES: Association between current smoking and socio-demographic variables, history of smoking, age of smoking initiation, smoking behaviour among family members, knowledge of the harmful effects of smoking, and whether smoking is allowed in the presence of relatives and acquaintances. RESULTS: The prevalence of current smokers was 13.2% overall, ranging from 3.2% in those 12-13 years old to 31.1% in those aged 18-19. Some of the variables (nationality, fathers education, and smoking allowed in the presence of parents or teachers) found to be associated with current smoking in a univariate analysis were no longer significantly associated with smoking in the multivariate analysis. By multivariate analysis, knowledge of the harmful effects of smoking, age, smoking allowed in the presence of friends or brothers, and previous smoking were statistically significant determinants of current smoking. CONCLUSIONS: Current health education activities against smoking should be continued and extended to the young population to further reduce the prevalence of smoking and its health consequences. Religious antipathy toward smoking should be emphasised in any local anti-smoking campaigns.

Is HLA‐DRW 13 (W6) Associated with Juvenile Myoclonic Epilepsy in Arab Patients?

Summary: In a study of 32 unrelated Arab patients with juvenile myoclonic epilepsy (JME), we compared the frequencies of human leukocyte antigen (HLA) class I and II alleles with those of unrelated healthy controls. A significant difference between the phenotypic frequencies in JME patients and controls was observed for DRW13, the split of DRW6 (37.5 vs 11% of controls). The strength of association as measured by the relative risk was 4.85 for this antigen (p = 0.002). The possible association of JME with HLA‐DRW6 recently reported in Caucasians was confirmed in this study. This finding speaks for the homogeneity of the disease among Arabic and Caucasian JME patients. The existence of this association is evidence of a locus in the HLA region that influences expression of JME.

Chronic cough at a non-teaching hospital: Are extrapulmonary causes overlooked?

Objective: To estimate the prevalence, assess the diagnostic approach and to identify specific causes and treatment response of chronic persistent cough (CPC) in consecutive adult patients attending the chest clinic at a non‐teaching hospital in Riyadh, Saudi Arabia.

Reproductive potential after an ectopic pregnancy.

OBJECTIVE To measure statistically how soon pregnancy can occur after an ectopic pregnancy (EP) so as to determine the cumulative pregnancy rate and the risk factors involved in nonpregnancy. DESIGN The risk of not getting pregnant after an EP (survivorship) was estimated for 120 patients followed up for up to 60 months using the actuarial life-table technique. The risk factors involved in nonpregnancy, abortions, or live births were analyzed, using Cox regression models. SETTING King Khalid University Hospital, Riyadh, Saudi Arabia. RESULTS There were 68 pregnancies over the study period, with a conception rate of 56.7%. Using the actuarial life table, the cumulative probability of not achieving pregnancy in a patient decreased sharply during the first 12 months, followed by a gradual decrease up to 48 months. The Cox regression analysis showed a correlation between pregnancy and two variables, namely, age and history of prior EP. The chances of a pregnancy resulting in abortion or live birth also correlated with the presence of prior infertility, pelvic inflammatory disease (PID), or postoperative complications. CONCLUSION Age and prior EP are important determinants in pregnancy rates after an EP. Similarly, history of PID, infertility, and postoperative complications are important risk factors in whether the pregnancy goes to term or ends in abortion.

Providing antenatal services in a primary health care system

A study sample of 880 women attending the primary health care center in the Al-Baha region of Saudi Arabia was interviewed on their attitudes towards antenatal care services in the primary care setting. Some 91.3% of the women expressed positive views about obtaining the antenatal care in these centers. The major factor influencing their choice was the geographic location of primary health centers which are near to their residence and therefore more convenient for them to patronize. Other factors were the easier access to staff in primary care centers, especially mid-wives and female doctors. There was a significant relationship of age, parity and education with their current antenatal and delivery practices. The women also recommended less than ten antenatal visits before delivery. These findings are relevant to any policy regarding maternity services in the country.

The growth pattern of Saudi Arabian pre-school children in Riyadh compared to NCHS / CDC reference population.

This study compares the growth patterns of Saudi Arabian pre-school children aged 0-5 years to a reference population of American children documented by the National Center for Health Statistics/Centers for Disease Control (NCHS/CDC). The anthropometric data of weight, height and age were collected in a cross-sectional study of Saudi Arabian children in Riyadh, the capital of Saudi Arabia. The sample selection was accomplished by a 3-stage stratified random procedure, basing the stratification on location and a socio-economic index. A total of 3,795 children comprising 55.2% males and 44.8% females had complete basic anthropometric measurements among other variables. Analyses were effected by using the WorHealth Organization/Centers for Disease Control (WHO/ CDC) standard software programme for calculating nutritional indicators. A combination of height for age (as an indicator of stunting) and weight for height (as an indicator of wasting) showed that a sizeable proportion (78.1%) have normal or slightly above normal nutritional status. A small proportion of the children (1.4%) were below -2.0 SD scores of the reference population for weight for height and for age. Overall, Saudi Arabian children are slightly shorter and thinner than their American counterparts. An important finding in weight for height was that nearly 20% of the children were below -2 SD scores of the reference population median. However, due to the very high per capita income, and the fact that food and other essential items are subsidised by the government, the deficits from this reference population may be attributed to inadequate health education nutrition programmes, genetic and other social factors including reproductive behaviour, rather than malnutrition.

Sickness Absenteeism among Employees of a Teaching Hospital in Saudi Arabia

The sickness absence records of workers at the King Khalid University Hospital over a period of two years (1990-1991) were analysed to identify the category of workers at high risks. The records of each staff who went on sick-off are available at the Employee Health Clinic of the hospital. There were 861 workers with sickness absence records during the period of study and 86% are expatriates on contract. The prevalence of sickness absence is higher among contract workers than non- contract workers about 16% and 9% respectively. The sex ratio was 1:2 in favour of females among contract employees but 1.2:1 in the males favour for the Saudis. The observed sex differential in the rate of sickness absence in each occupational group is statistically significant (P<0.01). Females have more spells of sickness than males and the duration of sickness absence is significantly higher in females. However, the average spell of sickness which is generally low is not different between contract and non-contract workers although slightly higher in the former. There was no significant occupational effect on the spells and duration of sickness absence. Respiratory infections and diseases of the digestive and musculoskeletal systems are the major diseases causing sickness absence. The implications of these findings are discussed in the paper. But for a good monitoring of sickness absence records, a health record surveil lance card for each employee is recommended.