Jamal S. Jarallah

Prevalence and determinants of smoking in three regions of Saudi Arabia

OBJECTIVES To study the prevalence and determinants of cigarette smoking among Saudi nationals in three regions of Saudi Arabia. PARTICIPANTS A sample of 8310 individuals aged 15 years and above from both sexes, randomly selected from the three regions, using a stratified cluster sampling technique. DESIGN A cross-sectional, household, community-based survey. Using a predesigned and tested questionnaire, the participants were interviewed by primary care physicians. The interview covered personal, social, and educational characteristics of the respondents, and also included questions about their smoking status, duration of smoking, and daily cigarette consumption. MAIN OUTCOME MEASURES Association between current smoking and sociodemographic variables, in univariate and multivariate analysis. Degree of interaction between the different determinants of cigarette smoking. RESULTS The overall prevalence of current smoking was 21.1% for males and 0.9% for females. Most smokers (78%) were young to middle-aged (21–50 years old). Smoking prevalence was higher among married people, among uneducated people, and among those in certain occupations: manual workers, businessmen, army officers, and office workers. CONCLUSIONS Cigarette smoking is an important public health problem in Saudi Arabia. A more intense and comprehensive tobacco control effort is needed.

INTRALESIONAL TREATMENT OF CUTANEOUS LEISHMANIASIS WITH SODIUM STIBOGLUCONATE ANTIMONY

Background. Cutaneous leishmaniasis represents a difficult disease to manage in endemic areas. Systemic treatment is hampered by both expense and compliance. Side effects may play a major role in this aspect as well.

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.

Epidemiology of Infantile Hydrocephalus in Saudi Arabia: Birth Prevalence and Associated Factors

Introduction: Hydrocephalus is a common central nervous system disorder in children. In spite of its importance, it has not been subjected to sufficient epidemiological studies, particularly in the developing countries. The aim of this study was to provide information from a representative series of newly diagnosed cases of infantile hydrocephalus on the birth prevalence, associated factors and mortality. Methodology: A prospective study was conducted over a 1-year period from April 1996 to March 1997 in the city of Al-Madinah Al-Munawarah, Saudi Arabia. Except for neural tube defects and brain tumors, all cases of hydrocephalus diagnosed within the first 28 days of life were included. A control group of 104 subjects was studied for comparison. Information about antenatal, natal and early postnatal periods were obtained by interviewing the mothers of the newborns. Results: During the study period, 26 cases of infantile hydrocephalus were detected. The birth prevalence was 1.6 per 1,000 live births. There was no sex preponderance as the male to female ratio was 1.2:1. Multiple pregnancies were detected in 21 (81%) cases. Nineteen (73%) cases were the product of consanguineous parent and 4 patients had a positive family history of hydrocephalus. The number of preterm infants was 16 (62%). The number of low birth weights (less than 2,500 g) was 18 (69%). An Apgar score of less than 8 occurred in 18 (69%) cases. The mode of delivery was vaginal in 15 (58%) women. The 6 months mortality rate was 23% (6 infants). Conclusion: The birth prevalence of infantile hydrocephalus in this study was significantly higher than in the developed countries. A positive family history of hydrocephalus, low birth weight, low Apgar score and abdominal delivery were found to be associated factors. The mortality rate in the first 6 months of life was significantly higher in hydrocephalus infants than in controls.

A preliminary report on the effect of referral system in four areas of the Kingdom of Saudi Arabia.

The effect of implementation of the referral system in health care was studied in four administrative regions of the Kingdom of Saudi Arabia. The study covered the six-month period before and after the implementation of the system. These regions represented the northern, southern, eastern, and central parts of the country. The western region was not included because it was late to implement the system. The study concentrated on the changes that took place in the workload and types of patients problems in hospitals and primary health care centers. The study covered Majma, Dammam Central, Hail General, and Abu Arish hospitals and the 107 health centers attached to them. The size of the hospitals at the time of implementating the referral system was considered during the design of the study. The referral rate was found to range from 3.2 to 4.2%. The number of patients attending the hospital outpatient departments decreased from 43.7% to 65%, but the number of patients attending the accidents/emergency departments increased from 1 to 129.7%. The consultations at the health centers increased from 2.5 to 35.2%. More severe conditions were managed at hospital outpatient departments, while less severe cases were screened and managed at the health care center level. The average duration of stay in all the hospitals remained approximately the same, except for Abu Arish Hospital where it declined by 50%. The bed occupancy rates showed a slight decrease in Dammam and Majma and increase in Hail and Abu Arish. The study suggested certain steps that are necessary to sustain improvement in the referral system.

Teaching and evaluation methods of medical ethics in the Saudi public medical colleges: cross-sectional questionnaire study.

BackgroundSaudi Arabia is considered one of the most influential Muslim countries being as the host of the two most holy places for Muslims, namely Makkah and Madina. This was reflected in the emphasis on teaching medical ethics in a lecture-based format as a part of the subject of Islamic culture taught to medical students. Over the last few years, both teaching and evaluation of medical ethics have been changing as more Saudi academics received specialized training and qualifications in bioethics from western universities.MethodsThis study aims at studying the current teaching methods and evaluation tools used by the Saudi public medical schools. It is done using a self-administered online questionnaire.ResultsOut of the 14 medical schools that responded, the majority of the responding schools (6; 42.8%), had no ethics departments; but all schools had a curriculum dedicated to medical ethics. These curricula were mostly developed by the faculty staff (12; 85.7%). The most popular teaching method was lecturing (13; 92.8%). The most popular form of student assessment was a paper-based final examination (6; 42.8%) at the end of the course that was allocated 40% or more of the total grade of the ethics course. Six schools (42.8%) allocated 15-30% of the total grade to research.ConclusionAlthough there is a growing interest and commitment in teaching ethics to medical students in Saudi schools; there is lack of standardization in teaching and evaluation methods. There is a need for a national body to provide guidance for the medical schools to harmonize the teaching methods, particularly introducing more interactive and students-engaging methods on the account of passive lecturing.

Public attitude towards acceptability, availability, and accessibility of immunization services in Riyadh.

A study of accessibility, availability, and acceptability of immunization was carried out by interviewing 1422 parents selected randomly from the catchment areas of 15 health care centers in Riyadh. The parents were included if they had children who were under two years or who had not completed the essential immunization necessary for issuing birth certificates. The demographic data of parents and children were also obtained. The majority, 1270 (89.3%) parents said they would immunize their children to protect them against diseases while only 25 (1.8%) of the parents said they immunize their children to obtain the birth certificate. Of all parents, 87.3% strictly followed the immunization schedule. Mothers in the younger age group, with higher education and whose husbands are in the higher occupational category had higher compliance rates than others. Various reasons were given for this failure. Parents (21.4%) attributed failure to attend the scheduled immunizations to inaccessibility to the service, for example the distance which needed transport, or non-availability of father to accompany the family to the health center. Other reasons for failure were due to false perception of the necessity, the indications and the contradictions of immunization. It was found that parents who failed to comply with the immunization schedule were more likely to have more than the average number of children.

Long-term care experience in Saudi Arabia

The objective of this study was to ascertain the clinical and epidemiological pattern of long-term care inpatients in Saudi Arabia. A cross-sectional survey of all long-term care inpatients facilities in the Ministry of Health was conducted during the period January-June 1994. Trained research teams consisting of physicians, social workers, nurses and medical record officers completed a pre-designed data form. They interviewed the treating teams, patients and their relatives. The data form consisted of socio-demographic data of patients, the duration of their stay in hospital and their clinical, social and psychological characteristics. In addition, the perceptions and preferences of doctors, patients, and their relatives about patient management in hospital vs home care were sought. Out of all patients, 61.3% were males, while 52.7% were elderly patients (> or = 60 years of age). Forty-three percent did not need any nursing care or required only routine nursing care. The treating doctors believed that 44.9% of patients could be cared for at home. However, 45.2% of the patients preferred to stay in hospital, while 67.5% of their relatives preferred institutional care. It is concluded that there is a need to plan for more cost-effective facilities for these patients. The proposed health services have to be culturally acceptable in order to encourage patients and their relatives to utilize them.

A prospective study of the morbidity pattern of patients seen at a university primary care clinic.

Information on the morbidity pattern of patients seen at a primary care clinic is sparse or not available for most countries in the Middle East including Saudi Arabia. A prospective study of all new patients at the primary care clinic of King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia was therefore carried out over a period of one year (1991G to 1992G). An analysis of the morbidity pattern of 9,441 new patients seen over this period is hereby reported. There is a male prepondence overall and more than 70% of the patients were below 40 years of age. III-defined illnesses, diseases of the skin, genitourinary, digestive, musculoskeletal and respiratory diseases accounted for more than 70% of the patients. About one-third of the patients, mainly those with diseases of the skin and genitourinary systems, were referred for specialist care. It is conceivable that the commonly observed pattern of diseases in this study may change over a period of time either due to the interventions adopted by the primary care clinics or as part of social development or as a cumulative effect of both. The primary physician has to be aware of such a change by periodically analyzing the available morbidity pattern.

Career preference and choice of practice locations by Saudi medical students

Summary. The identification of career preference and intended practice location of medical students may provide a useful contribution to the projections and distribution of doctors across different specialties in the country. Information for this study was obtained from a survey of medical students in the final years at King Saud University College of Medicine in Saudi Arabia. This included demographic characteristics, career choice, training location, qualification in view and intended practice locations. The majority (61.2%) intended to specialize and subsequently practise in the major disciplines of medicine, surgery, paediatrics and obstetrics. Twenty‐eight per cent were not sure of their future career choice. Only a few (3.5%) chose primary care and none chose pathology or anaesthesia. More men chose medicine, paediatrics and surgery, but more women chose obstetrics and primary care. The majority (81.2%) would like to have foreign certificates, but all the Saudis would subsequently practice in Saudi Arabia and mainly in large cities. The implications of this career pattern and practise locations are discussed with recommendations for health planners and medical schools.