Waleed A. Milaat

Population-based survey of childhood disability in Eastern Jeddah using the ten questions tool.

PURPOSE To identify the prevalence of handicapping disabilities among children up to 15 years of age and their epidemiological pattern in the eastern part of Jeddah. METHODS In a population-based cross-sectional household survey in the eastern Jeddah area, Saudi Arabia, a multistage sampling method was applied to screen children in 875 houses using the ten questions survey tool for identification of disabilities. Further information collected for detected disabilities included possible risk factors, cause of the disability as perceived by the family and services previously provided to the child. RESULTS A total of 137 cases of disability were detected giving a point prevalence rate of 36.7 per 1,000 children. Twenty-nine children (21.2%) were discovered for the first time during the survey. The majority of cases were male (57.7%) and the mean age for all cases was 10 years (SD = 5.5) with no case detected under one year of age. Disabled children were in the fourth or fifth birth order among their brothers and sisters and 47 (34%) of them were recorded as a second or third disability in the same family. Number of disabilities in the same child varied widely: 59% of cases had a single disability. 22% had two conditions and 19% had three or more conditions. Speech. motor and mental disabilities ranked top of the disabilities detected by the ten-question tool. The commonest cause of these disabilities as perceived by the family was hereditary diseases followed by childhood illnesses. Significant risk factors associated to these conditions included larger number of children in the family, older age of either parent. histories of handicapping conditions in the original families of either of the parents and presence of handicapping condition in the mothers. Families reported lack of services provided to their disabled children in the community. CONCLUSIONS The survey tool managed to document. successfully, a prevalence rate of childhood disabilities in the community with a general picture of their types and suspected causes which is quite comparable to that found in Saudi Arabia. It also reported a low service delivery for these disabilities and identified some risk factors related to their occurrence. It is recommended to apply this survey method with certain modifications to suit the local culture in Saudi Arabia. Improvement of the services rendered to handicapped children in Jeddah is also recommended.Purpose : To identify the prevalence of handicapping disabilities among children up to 15 years of age and their epidemiological pattern in the eastern part of Jeddah. Methods : In a population-based cross-sectional household survey in the eastern Jeddah area, Saudi Arabia, a multistage sampling method was applied to screen children in 875 houses using the ten questions survey tool for identification of disabilities. Further information collected for detected disabilities included possible risk factors, cause of the disability as perceived by the family and services previously provided to the child. Results : A total of 137 cases of disability were detected giving a point prevalence rate of 36.7 per 1000 children. Twenty-nine children (21.2%) were discovered for the first time during the survey. The majority of cases were male (57.7%) and the mean age for all cases was 10 years (SD = 5.5) with no case detected under one year of age. Disabled children were in the fourth or fifth birth order among their brothers and sisters and 47 (34%) of them were recorded as a second or third disability in the same family. Number of disabilities in the same child varied widely: 59% of cases had a single disability, 22% had two conditions and 19% had three or more conditions. Speech, motor and mental disabilities ranked top of the disabilities detected by the ten-question tool. The commonest cause of these disabilities as perceived by the family was hereditary diseases followed by childhood illnesses. Significant risk factors associated to these conditions included larger number of children in the family, older age of either parent, histories of handicapping conditions in the original families of either of the parents and presence of handicapping condition in the mothers. Families reported lack of services provided to their disabled children in the community. Conclusions : The survey tool managed to document, successfully, a prevalence rate of childhood disabilities in the community with a general picture of their types and suspected causes which is quite comparable to that found in Saudi Arabia. It also reported a low service delivery for these disabilities and identified some risk factors related to their occurrence. It is recommended to apply this survey method with certain modifications to suit the local culture in Saudi Arabia. Improvement of the services rendered to handicapped children in Jeddah is also recommended.

Is There a Role for Automated Eosinophil Count in Asthma Severity Assessment

Advances in asthma clinical assessment help in categorizing patients based on their clinical severity. Eosinophilia is a common laboratory finding in asthmatics. This paper explores the correlation between the clinical severity of asthmatic children and the degree of total peripheral eosinophil count (TPEC). Eighty asthmatic children referred to pediatric and allergy clinics were selected. Their clinical severity levels were assessed using the recent Global Strategy for Asthma Management and Prevention guidelines. Absolute TPEC was performed for all cases by the Cell-Dyne 3500 automated hematology counter. Correlation between clinical severity and TPEC was measured and their means in each severity group were compared for any significant association. Asthmatic children aged between 6 months and 15 years (mean = 5.9 years; 67.5% male) were studied. The clinical severity of their bronchial asthma was divided into four groups: intermittent (6, or 7.5%), mild-persistent (48, or 60%), moderate persistent (20, or 25%), and severe-persistent (6, or 7.5%). TPEC for the groups ranged between 10 and 2100 cells/mm3 (mean = 581.7 cells) and showed a very significant positive correlation with increased asthma severity (R = 0.61, p<0.001). A high linear trend of TPEC within each clinical group was found (F = 51.3, p<0.0001), and the means among each group also showed a significant increase as asthma severity level increased (F = 19.98, p<0.001). The study documents a significant positive correlation between the clinical severity of bronchial asthma and eosinophil counts. The authors advocate the use of this simple and sensitive laboratory test as a significant adjunct objective technique in the assessment of asthma severity and management.

Factors affecting the use and attitude towards medical resources and educational methods in a Saudi medical school.

Medical colleges are using various teaching methods and educational resources in education. In order to explore the attitude of medical students towards these educational methods and resources and the factors playing a major role in their use in a medical school in an Arabic culture, a self answered questionnaire was directed to 283 medical students in their clinical years. Questions on the possible factors which affect the attendance and the use of these education resources were also included. Traditional methods of teaching, lectures, and clinical rounds were found to be the backbone of the educational process in this college. Attendance to lectures was related to both quality of subjects and to the lecturer, emphasizing the importance of a good lecture and lecturer. Clinical bedside teaching was found to be a popular and effective way of teaching medical knowledge, skill, and patient interactions to medical students. The library in this college was the least used resource and student appreciation of its importance was very low. General recommendations are to reduce dependence on lectures gradually in clinical years and to introduce new methods of clinical teaching.

Effects of Cigarette Smoking on Lung Function of Saudi Students

This study was carried out to investigate the association between cigarette smoking and state of lung function among Saudi male students. A cross sectional study was conducted on a group of 680 male Saudi students. Detailed personal questionnaire, British Medical Research Council questionnaire on respiratory symptoms and smoking habit, were administered and forced spirometry and anthropometric measurements were conducted on them. Multiple regression models were used to study the cumulative effect of smoking on the function of the lung of smoking students. The percentage of cigarette smoking among the studied group was 20.29%. Smoking students had significantly lower values for lung function tests (FEV1%, FEF200-1200, FEF25-75, FEF75-85, and PEFR) compared to non-smokers. After controlling for other confounding variables, increased duration of smoking and number of cigarette smoked per day were significantly associated with more limitation of airflow in airways of the smoking young students. Recommendations were discussed accordingly.

Flow Volume Curves as Screening Tests for Early Effects of Smoking in Asymptomatic Children and Young Adults

The objectives of this study were to investigate the early effects of smoking on ventilation function of the lungs of children and young adults, and to determine the suitable lung function tests that can be used for screening of this effect. Medical and personal questionnaires, spirometric tests for twelve different lung function indices as well as anthropometric measurements were conducted on 538 randomly selected asymptomatic subjects (134 smokers, 404 non-smokers). Smokers had significantly lower values for peripheral airway lung function tests compared to non-smokers and this is evident within a few years of initiating smoking. The number of cigarettes smoked per day was also significantly associated with decrease to these lung function parameters. Lung function tests suitable for screening were identified. The number of cigarettes and duration of smoking seem to interact to increase the insult on the peripheral airway function in children and young adults suggesting an irritant effect, probably mediated through an airway inflammation which starts at the periphery of the lungs. Lung function tests used here can be the early indicators of early changes in asymptomatic children and young adults and can be a valuable screening tool.

Reproductive health profile and circumcision of females in the Hali semi-urban region Saudi Arabia: A community-based cross-sectional survey.

BACKGROUND Improving the reproductive health of females has become the focus of the developmental efforts of many nations. OBJECTIVES To identify the reproductive health style of married females, and to determine the prevalence and predictors of circumcision among girls aged ≤18 years in Hali semi-urban region. DESIGN A cross-sectional household survey SETTING Houses in Hali, Al-Qunfudhah governorate, western Saudi Arabia during 2017. SUBJECTS AND METHODS A multistage systematic cluster random sampling method was used to select participants. A validated questionnaire was used in interviewing the head of the selected houses. MAIN OUTCOME MEASURES Reproductive health profile of women, and circumcision of girls. SAMPLE SIZE 365 households. RESULTS Reproductive life starts early in the Hali region as 41.4% of women are married at or before 18 years of age. Consanguinity was recorded in 57.0% of houses. The prevalence of grand multiparity (GMP) was 54.7%; it was significantly associated with current maternal age, age at marriage, low educational levels of both parents and husbands with non-professional jobs. Current use of birth control methods was reported by 28.9% of families, and oral contraceptives (OCs) were the commonest method. Contraceptive use was significantly associated with higher educational levels of both parents and with women having professional work. The prevalence of circumcision was 80.3%. Circumcision was most frequent (59.4%) at age 7 years or less, and almost always done by doctors (91.4%). Hemorrhage (2.9%) and fever (2.3%) were the minimal recorded complications. Girls with higher parental education, enough income, no parental consanguinity, and whose mothers married at an older age had slightly lower rates of circumcision, but the difference was without statistical significance. CONCLUSION The pattern of early female marriage, high consanguinity, GMP, low contraceptive use, and a high frequency of circumcision in girls was apparent in Hali. Public health education and legislative policies are needed. LIMITATIONS Recall bias may affect the reported frequency of circumcision, and related complications.

Public health in the saudi health system: A search for new guardian

Saudi Arabia has witnessed a significant improvement in its health indicators. The kingdom has spent generously on the curative health services and established hundreds of hospitals and primary health care centers. However, we believe that this huge health expenditures and the presence of curative services is not the only reason for this improvement. Public health services have also had a significant impact on peoples health and that this improvement is due to a combination of public health programs such as immunization, environmental sanitation and health education with good formulation of sound health policies and health delivery systems. It is noted that health plans and expenditure in the health system are concentrating on the curative aspects and there is a significant weaknesses in public health services. Additionally, most jobs are allocated for curative care and there is scarcity of job titles related to public health in the health structure, such as public health officers, public health inspectors and public health specialists. A suggested body namely, Ministry of public health, will work to confirm that all issues related to health of the public in every aspect of daily life in the kingdom are within the genuine interest of all policy makers.