Tawfik A. Khoja

Intestinal parasitic diseases in Riyadh, Saudi Arabia: prevalence, sociodemographic and environmental associates.

Summary Our objectives were to assess the prevalence of intestinal parasitic infections in Riyadh and to determine associated sociodemographic and environmental factors. The study was conducted through a household survey. Three health centres were chosen from each of the five Riyadh urban regions and 15 from rural areas. Based on the average family size, a random sample of households were chosen. All household members were asked to participate in the study. Data were collected using a pre‐designed questionnaire eliciting data on sociodemographic and environmental factors. A stool specimen of each individual was examined microscopically for the presence of trophozoites and cysts. Six thousand and twelve participants with a mean age of 23.3 ± 17.4 (median 19 years, 48.6% males) were studied and 32.2% were infected. The infection rate was high in urban areas (33.3%), among children <12 years (34.4%), non‐Saudis (42.2%), single persons (34.9%), illiterate individuals (33.8%), those who obtained drinking water from tankers (36.1%) and those who disposed of sewage in open channels (47.1%). Stratified analysis showed that for Saudis <12 years parasitic infections were significantly higher among tanker users (39.5%) and septic tank users (36.8%). For Saudis≥12 years low education, water storage and open sewage disposal were statistically associated with parasitic infections (P < 0.05). Among expatriates, infections were high among males (47.6%), urban residents (48.3%), single persons (46.9%), tanker users (39.5%) and septic tank users (78.6%). Multivariate logistic regression analysis showed that age <12 years, non‐Saudi nationalities, educational level below secondary school, tanker as source of water and open sewage disposal were independently associated with high intestinal parasitic infection.

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.

Smoking behaviour and attitudes among adult Saudi nationals in Riyadh City, Saudi Arabia.

OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems.

Epidemiology of abnormal glucose metabolism in a country facing its epidemic: SAUDI‐DM study

Saudi Arabia is a community thrilled by sudden social and economical changes, leading to a sharp increase in the prevalence of abnormal glucose metabolism. Age‐specific diabetes and impaired fasting glucose prevalence is the focus of this study with the expected risk factors.

The prevalence of obesity among saudi males in the Riyadh region.

Attendees of 15 health centers in urban and rural areas in the Riyadh region were screened for obesity during May and June 1994. Systemic selection yielded 1580 Saudi males for analysis. The mean age was 33.6 +/- 13.5 years and body mass index (BMI) was 26.9 +/- 5.7 kg/m(2). Only 36.6% of subjects were their ideal weight (BMI < 25 kg/m(2)), while 34.8% were overweight (BMI 25-29.9 kg/m(2)), 26.9% were moderately obese (BMI 30-40 kg/m(2)) and 1.7% were morbidly obese (BMI > 40 kg/m(2)). Middle age, lower education and joblessness predicted a higher risk for obesity. Patients living in a rural areas had greater BMIs than those living in urban areas (P <0.01). Forty percent of overweight participants did not think they were so. The high prevalence of obesity and the lack of awareness among those afflicted emphasizes the need for community-based programs for preventing and reducing obesity, since weight control is effective in ameliorating most of the disorders associated with obesity, such as Type II non-insulin-depedent diabetis mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis of the knees. Young parents who are at risk of developing obesity and who play a central role in perpetuating it in their offspring should be the target of obesity-prevention programs.

CUTANEOUS LEISHMANIASIS IN RIYADH REGION: FOUR‐YEAR STUDY OF THE EPIDEMIOLOGIC AND CLINICAL FEATURES

A retrospective study of 11,802 patient records with cutaneous leishmaniasis in Riyadh region was conducted during the period 1987 to 1990. The following findings resulted from the study. The incidence rate declined from 244.2 to 106.5 per 100,000 population. The infection was mainly among non‐Saudi men in their working years. The Saudis represented 33% of the total number of patients. The Saudi patients were mainly young, below 15 years of age, with almost equal men/women distribution. The non‐Saudis were found to have more multiple lesions; 65% of them had three or more lesions compared with 10% in Saudis. The lesions were mainly on the exposed parts of the body such as the face (20%), neck (3.3%), upper limbs (23.3%), and lower limbs (15%). Agricultural areas such as Riyadh vicinity, Al‐Kharj, Shagraa, and Al‐Koweeya showed consistently the highest foci of infections. The infections were highest in winter and lowest in summer.

Community-based study of obesity among children and adults in Riyadh Saudi Arabia.

Nowadays obesity is a major public health problem. It is a main risk factor for many fatal diseases. Our study aimed to determine the prevalence of obesity among children and adults in Riyadh and to investigate the associated sociodemographic factors. A cross-sectional, population-based sample of Riyadh was selected through the two-stage cluster sampling technique. All participants attended the local primary health-care center, and a questionnaire interview to obtain sociodemographic data was completed for each. Anthropometric measurements of weight and height were performed. Body mass index (BMI) was calculated, and children having a BMI ≥ 95th age- and sex-specific percentile and adults with a BMI ≥ 30 were considered obese. There were 4,775 participants: 1,848 children and 2,927 adults. Among the children, 10.5% were overweight and 8.7% were obese. Among the adults, 32.4% were overweight and 21% were obese. Among children, a multivariate logistic regression analysis showed that age 6 to 10 years (odds ratio, 2.21; 95% confidence interval, 1.4–3.5) and non-Saudi nationality (odds ratio, 2.2; 95% confidence interval, 1.31–3.7) were associated with childhood obesity. Among adults, urban residence (odds ratio, 1.5; 95% confidence interval, 1.23–1.83), female sex (odds ratio, 2.03; 95% confidence interval, 1.64–2.53), and marriage (odds ratio, 2.11; 95% confidence interval, 1.57–2.82) were associated with obesity in adults, as was Saudi nationality and age above 30 years. Obesity is an important public health problem in Riyadh.

Anxiety and Depression Among Primary Care Patients in Riyadh

Primary care physicians deal with a large proportion of mentally ill patients. Emotional disturbances such as depression and anxiety may coexist with physical illnesses, leading to complicated clinical presentations, poor response to treatment, and frequently, unnecessary investigations, procedures, and referrals to special

Asthma in Saudi Arabia: is the system appropriate for optimal primary care?

The objective of the study was to assess the suitability of the structure of Primary Health Care Centers to cater to the needs of patients with asthma. Standards for optimal care were defined by the authors. The worst deficiencies identified were in the availability peak flow meters, inhaler devices and antiinflammatory drugs. Assessment of the optimal structure for asthma care was found to demonstrate variance with national standards. More effort is recommended in central development of guidelines. This assessment can be used to measure future changes in asthma care.

A community-based survey for different abnormal glucose metabolism among pregnant women in a random household study (SAUDI-DM)

Objective To assess the prevalence and risk factors of gestational diabetes mellitus (GDM) in a population known to have a high prevalence of abnormal glucose metabolism. Methods A household random population-based cross-sectional study of 13 627 women in the childbearing age, who were subjected to fasting plasma glucose if they were not known to have been diagnosed before with any type of diabetes. GDM cases were diagnosed using the International Association of Diabetes and Pregnancy Study Group (IAPSG) criteria. Results The overall GDM prevalence was 36.6%, categorised into 32.4% new cases and 4.2% known cases. Another 3.6% had preconception type 1 or 2 diabetes. GDM cases were older and had a significantly higher body mass index, in addition to a higher rate of macrocosmic baby and history of GDM. Monthly income, educational level, living in urban areas and smoking were not found to be significantly different between normal and GDM cases. The most important and significant risk factors for GDM were history of GDM, macrosomic baby, obesity and age >30 years. However, hypertension, low high-density lipoprotein, family history of diabetes and increased triglycerides did not show any significant effect on GDM prevalence in this cohort. Conclusions This society is facing a real burden of abnormal glucose metabolism during pregnancy, where almost half of the pregnant women are subjected to maternal and neonatal complications. Early screening of pregnant women, especially those at a high risk for GDM, is mandatory to identify and manage those cases.