Ibrahim Al Alwan

Time for an Adolescent Health Surveillance System in Saudi Arabia: Findings From “Jeeluna”

PURPOSE With the increasing burden of noncommunicable disease, adolescence is viewed as an opportune time to prevent the onset of certain behaviors and promote healthy states. Although adolescents comprise a considerable portion of Saudi Arabias population, they have received insufficient attention and indicators of their health status, as a first step in a prevention cycle are unavailable. This study was carried out with the aim of identifying the health risk behaviors and health status of adolescents in Saudi Arabia. METHODS This cross-sectional, school-based study was carried out in all 13 regions of Saudi Arabia. Through multistage, cluster, random sampling, intermediate, and secondary school students were invited to participate. Data were collected by means of a self-administered questionnaire addressing health risk behaviors and health status, clinical anthropometric measurements, and laboratory investigations. RESULTS A total of 12,575 adolescents participated. Various health risk behaviors, including dietary and sedentary behaviors, lack of safety measures, tobacco use, bullying, and violence were highly prevalent. Twenty-eight percent of adolescents reported having a chronic health condition, 14.3% reported having symptoms suggestive of depression, 30.0% were overweight/obese, and 95.6% were vitamin D deficient. CONCLUSION Behaviors and conditions known to persist into adulthood and result in morbidity and premature mortality are prevalent among adolescents in Saudi Arabia. Preventive measures and local health policies are urgently needed and can impact adolescents and future adults. Establishing adolescent health surveillance is necessary to monitor trends and impacts of such measures.

Obesity among Saudi children

Childhood obesity is considered as a serious health problem worldwide. The aim of this review is to evaluate the prevalence and the trends of obesity among Saudi children. A full search was conducted for all articles published between 2000 and 2012 on obesity in Saudi children. The latest national data revealed that the rates of overweight and obesity among school-age children have reached 23% and 9.3%, respectively. However, the rates of overweight and obesity among preschool children were reported as approximately 15% and 6%, respectively. A variation in the prevalence of obesity and overweight in children among geographical regions of the Kingdom was noted. Eastern and central regions have the highest prevalence of obesity and overweight and southern regions have the lowest prevalence of obesity and overweight. Both regional and national studies showed a trend of rising obesity over time. This review demonstrated that Saudi children have a high prevalence of obesity and being overweight with a rising trend. In light of these findings, it is evident that a national strategy is required to treat and prevent this serious health problem.Childhood obesity is considered as a serious health problem worldwide. The aim of this review is to evaluate the prevalence and the trends of obesity among Saudi children. A full search was conducted for all articles published between 2000 and 2012 on obesity in Saudi children. The latest national data revealed that the rates of overweight and obesity among school-age children have reached 23% and 9.3%, respectively. However, the rates of overweight and obesity among preschool children were reported as approximately 15% and 6%, respectively. A variation in the prevalence of obesity and overweight in children among geographical regions of the Kingdom was noted. Eastern and central regions have the highest prevalence of obesity and overweight and southern regions have the lowest prevalence of obesity and overweight. Both regional and national studies showed a trend of rising obesity over time. This review demonstrated that Saudi children have a high prevalence of obesity and being overweight with a rising trend. In light of these findings, it is evident that a national strategy is required to treat and prevent this serious health problem.

Clinical presentation and etiology of osteomalacia/rickets in adolescents

This study was conducted to determine the causes and clinical presentations of osteomalacia/rickets in adolescents seen at the King Abdulaziz Medical City (KAMC), Riyadh. Because osteomalacia and rickets constitute the same entity, the term osteomalacia will be used for future discussion. A retrospective file review was performed on all adolescents (10-16 years) with osteomalacia, defined as alkaline phosphatase levels ≥500 IU/L, seen at the KAMC, Riyadh, from 2000 to 2006. We recorded the signs and symptoms, dietary history and amount of sun exposure at presentation. A total of 135 patients were found to fit the inclusion criteria for the study. Of them, 57 had nutritional causes, with a mean age of 13.2 years, and included 32 females. At diagnosis, 22 patients were found to have bone pain, 10 had bone deformities, eight had pathological fractures and 17 were asymptomatic. Secondary causes for osteomalacia were found in 59 cases who had liver and renal disease and in 19 other patients who were on medications such as anticonvulsants and steroids, which are known to cause osteomalacia. Our study indicates that osteomalacia is a significant health burden that deserves special attention. Bone pain is the most common presenting symptom at diagnosis. Because of the high risk of osteomalacia associated with the use of anticonvulsants and steroids, it is advised that all patients on these drugs should be routinely screened for secondary osteomalacia.

The Effect of Parental Socioeconomic Class on Children’s Body Mass Indices

Objective: To assess the effect of education and economic status of parents on obesity in children. Methods: A cross-sectional survey was conducted in 2006 among school children in Riyadh, Saudi Arabia. A representative sample of 1243 (542 male and 701 female) children aged 6-16 years were contacted using multistage cluster sampling strategy. Social and demographic variables were collected using questionnaires completed by parents. Height and weight of the children were recorded by a trained team. Results: The mean body mass index for all children was 19.8±5.4. The prevalence rates of overweight and obesity were 21.1% and 12.7%, respectively. Overweight and obesity were more prevalent in males than in females. By multivariate analysis, children were more likely to be overweight if they were male (OR=0.6, p<0.01), 12 years of age (OR=3.79, p<0.01, compared to age 6 years), and if their families had higher income (OR=3.12, p<0.01, compared to families with low income). Being male (OR=0.545, p <0.01), aged 12 years (OR=3.9, p=0.005, compared to the age of 6), and having a mother who is more educated were determined to be significant risk factors for obesity in children. Mothers educated at university level were found to have a three-fold higher risk of having obese children(OR=3.4, p<0.01, compared to mothers with lower education levels). Conclusions: Overweight and obesity among Saudi children is associated with educated mothers and higher family income. This finding calls for introducing interventions in health education for both children and parents. Conflict of interest:None declared.

Integration of evidence based medicine into the clinical years of a medical curriculum

Teaching Evidence Based Medicine (EBM) helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom) teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum.

Puberty Onset Among Boys in Riyadh, Saudi Arabia

Background The ages of onset of pubertal characteristics are influenced by genetic, geographic, dietary and socioeconomic factors; however, due to lack of country-specific norms, clinicians in Saudi Arabia use Western estimates as standards of reference for local children. Aims The aim of the Riyadh Puberty Study was to provide data on pubertal development to determine the average age of onset of pubertal characteristics among Saudi boys. Methods Cross-sectional study among male school children in Riyadh, Saudi Arabia, in 2006, 542 schoolboys, aged 6 to 16 years old, from diverse socioeconomic levels were selected into the sample using a cluster sample design. Tanner stages were ascertained during physical examination by pediatric endocrine consultants, and also trained pediatric residents and fellows. Results The mean age (standard deviation) at Tanner Stages 2, 3, 4, and 5 for pubic hair development of Saudi boys was 11.4 (1.6), 13.3 (1.3), 14.4 (1.0) and 15.1 (0.8) years old, respectively. For gonadal development, the mean age (standard deviation) at stages 2, 3, 4, and 5 were 11.4 (1.5), 13.3 (1.2), 14.3 (1.1) and 15.0 (0.9) years old, respectively. Conclusion The ages of onset of pubertal characteristics, based on gonadal development, among Saudi boys are comparable to those reported in Western populations.

Developing the science of selection into the healthcare professions and speciality training within Saudi Arabia and the Gulf region

Research about the selection of students into health care practitioner programs, principally medical programs, and into specialty training has become a worldwide phenomenon. Set against a rapid expansion of healthcare professional students, there have been calls to make national policy considerations and provide guidance for an evidence-based selection process. This article considers the implications of the international research base underpinning current selection processes, and makes recommendations for policy makers, health educators, and institutional leaders to consider. We recommend that selection procedures into health professional education and specialty training becomes part of an international conversation that takes account of the complexities of local context, the evidence base into what works and what does not, and the efficient and effective use of resources.

Decline in menarcheal age among Saudi girls.

Objectives: To estimate age at menarche and to assess trends in menarcheal age among Saudi women. Methods: A prospective longitudinal study was conducted among healthy prepubertal female school children and adolescents from September 2006 to July 2012 in Riyadh, Kingdom of Saudi Arabia. Study participants were invited from diverse socioeconomic backgrounds. Tanner stage, height, weight, body mass index, and socioeconomic parameters including parent’s level of education were collected. Age at menarche was compared with maternal age at menarche. Results: The study included 265 girls and mothers. Mean±standard deviation (SD) age at menarche for girls was 13.08 ± 1.1 years, and their distribution category across the ≤10 years was 4 (1.5%), 11-14 years was 239 (90.2%), and ≥15 years was 22 (8.3%) girls. Anthropometric measurements, mother’s level of education, and family income were not statistically significant determining factors associated with age at menarche. Mean ± SD age at menarche for mothers was 13.67 ± 1.4 years, and their distribution category across the ≤10 years was 7 (2.6%), 11-14 years was 172 (64.9%), and ≥15 years was 86 (32.5%). Girls attained menarche at younger age compared with their mothers (p<0.0001). A downward secular trend in age of menarche was observed (Cuzick test for trend = 0.049). Conclusion: Saudi girls attain menarcheal age earlier than their mothers, reflecting a downward secular trend in menarcheal age.