Maha Almuneef

Adverse childhood experiences, chronic diseases, and risky health behaviors in Saudi Arabian adults: A pilot study

Adverse childhood experiences (ACEs) have been linked with risky health behaviors and the development of chronic diseases in adulthood. This study examined associations between ACEs, chronic diseases, and risky behaviors in adults living in Riyadh, Saudi Arabia in 2012 using the ACE International Questionnaire (ACE-IQ). A cross-sectional design was used, and adults who were at least 18 years of age were eligible to participate. ACEs event scores were measured for neglect, household dysfunction, abuse (physical, sexual, and emotional), and peer and community violence. The ACE-IQ was supplemented with questions on risky health behaviors, chronic diseases, and mood. A total of 931 subjects completed the questionnaire (a completion rate of 88%); 57% of the sample was female, 90% was younger than 45 years, 86% had at least a college education, 80% were Saudi nationals, and 58% were married. One-third of the participants (32%) had been exposed to 4 or more ACEs, and 10%, 17%, and 23% had been exposed to 3, 2, or 1 ACEs respectively. Only 18% did not have an ACE. The prevalence of risky health behaviors ranged between 4% and 22%. The prevalence of self-reported chronic diseases ranged between 6% and 17%. Being exposed to 4 or more ACEs increased the risk of having chronic diseases by 2-11 fold, and increased risky health behaviors by 8-21 fold. The findings of this study will contribute to the planning and development of programs to prevent child maltreatment and to alleviate the burden of chronic diseases in adults.

Self Reported Awareness of Child Maltreatment among School Professionals in Saudi Arabia: Impact of CRC Ratification.

OBJECTIVESnThe Convention on the Rights of the Child (CRC) was ratified by Saudi Arabia 15 years ago; yet addressing the issue of child maltreatment only began in more recent years. School professionals play a significant role in childrens lives, as they spend a great deal of time with them and are hence essential to protecting and identifying those in danger or at risk. The objective of this study is to identify school professionals awareness of child maltreatment and the existing national policies and procedures to examine the extent of efforts made in Saudi Arabia and to activate the roles of schools and school professionals in protecting children from violence and implementation of Article 19 of the CRC.nnnMETHODSnThis was a cross-sectional study, where school professionals from randomly selected schools throughout the country were invited to participate in a self-administered questionnaire.nnnRESULTSnA total of 3,777 school professionals participated in the study. Fifty-five percent of professionals had at least 10 years of work experience. A low-level of awareness of child maltreatment was found in about 1/3 of school professionals. Only 1.9% of school professionals had ever attended any sort of specific training on child maltreatment, though 69.3% of those who had not, were willing to attend future training. With regards to awareness of CRC Article 19 or policies and procedures addressing child maltreatment, only 22% reported being aware of it.nnnCONCLUSIONnThe majority of school professionals in Saudi Arabia have a low-intermediate level of awareness of child maltreatment, ratification of CRC, and related national policies and procedures, yet most are willing to attend training programs on this subject matter. Efforts need to be made in the country to fill this gap.

Brucella melitensis Bacteremia in Children: Review of 62 Cases

Abstract Brucella bacteremia is not uncommon in children living in endemic areas. Reports on brucella bacteremia, however, are scarce. Its clinical features and complications are unknown. This retrospective review describes the clinical and laboratory characteristics, the relapse rate, and response to different regimens of antimicrobials in children with brucella bacteremia over a 5-year period. Antimicrobial susceptibility testing was performed on all isolates. Data on 62 children with brucella bacteremia were collected between 1996 and 2000. All isolates were of Brucella melitensis species. Most children were between five and 10 years of age; males were twice as affected as females (66% vs 34%). Fever and arthralgia were the most common presenting symptoms, 81% and 48% respectively. Fever and arthritis were the most common physical findings, 81% and 19% respectively. Forty-five (73%) patients presented within 10 days of illness onset. Brucella titers were measured in all patients; 95% had a positive titer of 1:320 or more. Resistance to co-trimoxazole (sulfamethoxazole + trimethoprim) increased from 22% in 1996 to 66% in year 2000. Rifampicin and co-trimoxazole were the most commonly used combination in 50%, rifampicin, co-trimoxazole, supplemented with gentamicin or streptomycin in 27%. The median duration of therapy was 6 weeks. The overall relapse rate was 13% (95% CI, 4.6%-21.2%) but was higher among those with symptoms lasting >10 days (P<0.001). There was a high relapse rate among patients infected with co-trimoxazole-resistant species and treated with co-trimoxazole compared to patients infected with sensitive species who also received co-trimoxazole (22% vs. 8%), but this was not statistically significant (P = 0.16). Patients with brucella bacteremia present early in their course of illness. Their clinical features, however, did not differ from brucellosis patients who did not have bacteremia. Despite the high rate of in-vitro resistance to co-trimoxazole, this did not correlate with a significant relapse rate.

Determining child maltreatment incidence in Saudi Arabia using the ICAST-CH: A pilot study

Studies in other countries, including countries with mandated reporting by professionals and a long history of recognition of the problem, have found child abuse to be seriously under reported. This population-based pilot study was conducted to determine the magnitude of adolescents exposure to CAN at home, and to identify ethical and methodological challenges to conducting a survey on a culturally sensitive subject. This cross-sectional study was carried out in Al-Kharj city in 2011-2012. Through a stratified multistage cluster random sampling of schools, a sample of adolescents (15-18 years) were identified and invited to participate. The ISPCAN Child Abuse Screening Tool-Child: Home version (ICAST-CH) was used for data collection. The previous years incidence of physical, psychological, and sexual abuse, neglect, and exposure to violence were assessed. A total of 2,043 students participated in the study (mean age, 16.6 years; 58%, female). The incidence of psychological abuse, physical abuse, exposure to violence, neglect, and sexual abuse were 74.9%, 57.5%, 50.7%, 50.2%, and 14.0%, respectively. Female participants were at higher risk for psychological and physical abuse, exposure to violence, and neglect, but not for sexual abuse. The rates and gender distribution of CAN at home differ from findings of health-based records. Our results are comparable to other regional population-based studies. Thus, population-based data are necessary to inform and guide professionals and decision makers for prevention policies and resource allocation. Insights to ethical and methodological challenges surrounding the sensitive nature of this type of study are discussed.

Determining prevalence of maltreatment among children in the Kingdom of Saudi Arabia

PURPOSEnThe aim of this study is to find out the overall prevalence rates for the major forms of abuse among adolescents in the Kingdom of Saudi Arabia and the differences in prevalence by age, gender and living arrangement.nnnMETHODSnThe cross-sectional study was conducted in secondary high schools in five of the 13 main regions of Kingdom of Saudi Arabia during 2012. Through a multistage stratified sampling technique, a sample (nu2009=u200916u2009939) of adolescents (15-19u2009years) were identified and invited to participate. The ISPCAN Child Abuse Screening Toolu2009-u2009Child was used for data collection. The previous years occurrence of violence exposure, psychological, physical and sexual abuse, and neglect were assessed.nnnRESULTSnNearly 90% of the adolescents were between 16 and 18 years of age, and over 80% were cared for by both of their biological parents. Annual prevalence of various forms of abuse in the year before the 2012 assessment ranged between 0.10 and 0.65, with the lowest rate for sexual abuse and the highest for psychological abuse. Significantly, greater rates of all forms of abuse/exposure were found when participants lived with their mother or father only (versus with both), and even greater rates for all when they lived with their biological parent and a step-parent. Rates for violence exposure, psychological abuse and neglect were significantly greater for girls, and rate of sexual abuse was greater for boys.nnnCONCLUSIONSnMore attention should be given to the effect of adolescent maltreatment particularly among girls. In addition, sexual abuse prevention programme should be targeted among boys.

Non-suicidal self-strangulation among adolescents in Saudi Arabia: Case series of the choking game

Adolescence is known to be a time of exploration and initiation of risky behaviors. Much attention has been given to risk behaviors such as smoking, violence, and sexual promiscuity; other serious behaviors such as self-strangulation or the choking game, which is carried out by adolescents in response to peer pressures or to gain a transient sense of euphoria, have received little attention, with the available literature coming from the developed world. This is the first report of cases of non-suicidal self-strangulation from the Arab World. In this case series, we report 5 cases of non-suicidal self-strangulation that presented to the Emergency Department of a tertiary care hospital in Riyadh, Saudi Arabia during 2010-2012. All of the 5 cases were young male adolescents aged 10-13 years. This activity resulted in the death of 2 boys; one boy sustained hypoxic ischemic insult to the brain with clinical deficits; and the remaining 2 were fortunate to be discharged home in healthy condition. None of the cases had underlying mental health problems, and multidisciplinary involvement ruled out suicide and homicide activities. Non-suicidal self-strangulation is a fatal behavior that adolescents engage in. Increased efforts are needed to address this serious and preventable public health issue. Awareness and education of adolescents and their parents is crucial. Awareness of healthcare providers is also necessary in order to avoid misdiagnosis of such cases.

Gender-based disparities in the impact of adverse childhood experiences on adult health: findings from a national study in the Kingdom of Saudi Arabia

BackgroundAdverse Childhood Experiences (ACEs) have been linked to an increased risk of health and social problems throughout life. Studies on gender differences from developing countries are scarce. In this paper, we will examine gender variations in the types of reported ACEs and gender-specific relationships between cumulative ACEs and physical and mental health, and Risky Health Behaviors (RHB) in adulthood in the Kingdom of Saudi Arabia (KSA).MethodsA cross sectional national study was conducted in all of the 13 regions in KSA in 2013 using the ACE- International Questionnaire (ACE-IQ). We used multivariate logistic regression to examine the relationship between 4u2009+u2009ACEs and physical, mental health and RHBs for both men and women separately after adjusting for age, education, marital status and current employment.ResultsThe total number of participants was 10,156 and women comprised 48% of the sample. The majority of respondents (80%) reported at least one ACE. Women had higher percentages ofu2009<u2009=2 ACEs (65% vs 55%; p <0.05) while men were more likely to have 4+ ACEs (33% vs 25%; pu2009<u20090.05). When compared to participants with 0 ACE, men who reported 4+ ACEs were associated with the highest likelihood of using drugs (ORu2009=u20099.7; 95% CI: 6.4-14.5) and drinking alcohol (ORu2009=u20099.2; 95% CI: 6.3-13.6). On the other hand, women who experienced 4+ ACEs were associated with the highest likelihood of depression (ORu2009=u20097.0; 95% CI: 5.2-9.4), anxiety (ORu2009=u20096.4; 95% CI: 5.0-8.2) and other mental illnesses (ORu2009=u20097.4; 95% CI: 5.2-10.6). As for chronic diseases, abused men and women in childhood showed similarly a twofold increased risk of developing diabetes, hypertension, coronary heart disease and obesity when compared to non-abused participants.ConclusionFindings highlight the need to consider gender specific differences in the development of preventive strategies to address ACEs in KSA.

Adverse childhood experiences and association with health, mental health, and risky behavior in the kingdom of Saudi Arabia

BACKGROUNDnThe aim of this study is to determine if ACEs impact the health and risk behavior burden among Kingdom of Saudi Arabia (KSA) adults.nnnMETHODSnIn 2013, a cross-sectional study was conducted across KSA to identify the retrospective prevalence of ACEs and their association with high risk behaviors and chronic diseases. Surveys from 10,156 adults in all 13 Saudi regions were obtained using an Arabic version of the WHO ACE-IQ (KSA ACE-IQ).nnnRESULTSnCompared to respondents reporting no ACEs, even just one ACE contributed significantly to the odds of experiencing diabetes mellitus (OR=1.3), depression (OR=1.32), or anxiety (OR=1.79) outcomes. Two ACEs were necessary for statistically significant, higher odds to emerge for hypertension (OR=1.46), mental illness (OR=1.93), smoking (OR=1.17), alcohol use (OR=1.75), and drug use (OR=1.45). Respondents who reported four or more ACEs had greater odds of coronary heart disease (OR=1.94), and obesity (OR=2.25). Compared to those reporting no ACEs, respondents reporting four or more ACEs had over four times the odds of Alcohol or Drug Use, Mental Illness, Depression, and/or Anxiety outcomes and more than twice the odds of diabetes, hypertension, obesity, and/or smoking outcomes.nnnCONCLUSIONnFindings from this analysis underscore the potential benefit of providing focused preventative approaches to mitigating ACEs in KSA in relation to both the specific and cumulative burden of health and risky behavior outcomes.

Multidimensional model to assess the readiness of Saudi Arabia to implement evidence based child maltreatment prevention programs at a large scale

There has been increased awareness of child maltreatment in Saudi Arabia recently. This study assessed the readiness for implementing large-scale evidence-based child maltreatment prevention programs in Saudi Arabia. Key informants, who were key decision makers and senior managers in the field of child maltreatment, were invited to participate in the study. A multidimensional tool, developed by WHO and collaborators from several middle and low income countries, was used to assess 10 dimensions of readiness. A group of experts also gave an objective assessment of the 10 dimensions and key informants and experts scores were compared. On a scale of 100, the key informants gave a readiness score of 43% for Saudi Arabia to implement large-scale, evidence-based CM prevention programs, and experts gave an overall readiness score of 40%. Both the key informants and experts agreed that 4 of the dimensions (attitudes toward child maltreatment prevention, institutional links and resources, material resources, and human and technical resources) had low readiness scores (<5) each and three dimensions (knowledge of child maltreatment prevention, scientific data on child maltreatment prevention, and will to address child maltreatment problem) had high readiness scores (≥5) each. There was significant disagreement between key informants and experts on the remaining 3 dimensions. Overall, Saudi Arabia has a moderate/fair readiness to implement large-scale child maltreatment prevention programs. Capacity building; strengthening of material resources; and improving institutional links, collaborations, and attitudes toward the child maltreatment problem are required to improve the countrys readiness to implement such programs.

An unusual combination of extrapulmonary manifestations of tuberculosis in a child

We report the case of a 10-year-old girl who presented to the emergency department with acute abdominal pain. She was diagnosed as having extrapulmonary tuberculosis (TB) with multifocal osteomyelitis of the spine and ribs, peritonitis and intestinal involvement. We describe the clinical presentation of this unusual constellation of the disease in the absence of pulmonary involvement in a child and discuss the diagnostic challenges and treatment of these rare forms of TB.