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   2013| January-April  | Volume 20 | Issue 1  
    Online since March 7, 2013

 
 
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ORIGINAL ARTICLES
Economic costs of diabetes in Saudi Arabia
Abdulkarim K Alhowaish
January-April 2013, 20(1):1-7
DOI:10.4103/2230-8229.108174  PMID:23723724
Background: Diabetes imposes a large economic burden on the individual, national healthcare systems, and countries. Objective: To determine the economic impact of diabetes mellitus on Saudi healthcare system, both now and in the future. Materials and Methods: This research study uses a prevalence-based approach that combines the demographics of the population (classified by nationality, sex and age group) with and without diagnosed diabetes in 1992 and 2010. The economic impact of diabetes is estimated in this study, using secondary sources of information provided by Ministry of Health, Ministry of Finance and Central Department of Statistics and Information databases. Results: People diagnosed with diabetes, on average, have medical healthcare expenditures that are ten times higher ($3,686 vs. $380) than what expenditures would be in the absence of diabetes. Over 96% of all medical healthcare expenditures attributed to diabetes are incurred by persons of Saudi nationality, with the remaining 4% incurred by persons of non-Saudi nationality. The population age 45-60 incurs 45% of diabetes-attributed costs, with the remaining population under age 15 incurs 3.8%, age 15-44 incurs 27.5%, and age 60 and above incurs 23.8%. Conclusion: The actual national healthcare burden because of diabetes is likely to exceed the $0.87 billion estimated in this study, because it omits the indirect costs associated with diabetes, such as absenteeism, lost productivity from disease-related absenteeism, unemployment from disease-related disability, lost productivity due to early mortality by disease. The social cost of intangibles such as pain and suffering and care provided by non-paid caregivers as well as healthcare system administrative costs, cost of medications, clinician training programs, and research and infrastructure development is also omitted from this research study. Further studies are needed to confirm the present findings and to improve our understanding of economic costs of diabetes and its related complications.
  32 8,846 1,525
Antimicrobial resistance in pathogens causing urinary tract infections in a rural community of Odisha, India
Muktikesh Dash, Sanghamitra Padhi, Indrani Mohanty, Pritilata Panda, Banojini Parida
January-April 2013, 20(1):20-26
DOI:10.4103/2230-8229.108180  PMID:23723727
Background: Antimicrobial resistance of urinary tract pathogens has increased worldwide. Empiric treatment of community-acquired urinary tract infection (CA-UTI) is determined by antimicrobial resistance patterns of uropathogens in a population of specific geographical location. Objectives: This study was conducted to determine the prevalence of CA-UTI in rural Odisha, India, and the effect of gender and age on its prevalence as well as etiologic agents and the resistance profile of the bacterial isolates. Materials and Methods: Consecutive clean-catch mid-stream urine samples were collected from 1670 adult patients. The urine samples were processed and microbial isolates were identified by conventional methods. Antimicrobial susceptibility testing was performed on all bacterial isolates by Kirby Bauer's disc diffusion method. Results: The prevalence of UTI was significantly higher in females compared with males (females 45.2%, males 18.4%, OR = 2.041, 95% CI = 1.64-2.52, P ≤ 0.0001). Young females within the age group of 18-37 years and elderly males (≥68 years) showed high prevalence of UTI. Escherichia coli (68.8%) was the most prevalent isolate followed by Enterococcus spp. (9.7%). Amikacin and nitrofurantoin were the most active antimicrobial agents which showed low resistance rate of 5.8% and 9.8%, respectively. Conclusion: Our study revealed E. coli as the pre-dominant bacterial pathogen. Nitrofurantoin should be used as empirical therapy for uncomplicated CA-UTIs. In the Indian setting, routine urine cultures may be advisable, since treatment failure is likely to occur with commonly used antimicrobials. Therefore, development of regional surveillance programs is necessary for implementation of national CA-UTI guidelines.
  19 6,806 1,050
Prediction of sustained virologic responses to combination therapy of pegylated interferon-α and ribavirin in patients with chronic hepatitis C infection
Mona H Ismail
January-April 2013, 20(1):35-40
DOI:10.4103/2230-8229.108182  PMID:23723729
Background and Aim: Hepatitis C virus (HCV) infection is a major health problem worldwide. Genotype-4 is the most common genotype in Saudi Arabia. The response to treatment with pegylated interferon-α combined with ribavirin in chronic HCV infection varies. This study aimed at investigating the pre- and on-treatment predictors of sustained virologic response (SVR) in patients with chronic hepatitis C (CHC) infection. Patients and Methods : Clinical data of 48 patients with CHC treated with standard HCV antiviral combination therapy, between January 2005 and December 2010, at a Saudi University hospital, were retrospectively reviewed for age, sex, body mass index, liver enzymes, HCV-RNA viral load, liver biopsy, and response to treatment. The primary end point was SVR defined as undetectable HCV-RNA by polymerase chain reaction (PCR) 24 weeks after the end of treatment. Univariable logistic regression was used to explore the association between the different variables and SVR. These independent predictors of SVR were then analyzed with multivariable logistic regression analysis. Results: Of the 48 treated patients, 25 (52%) were females and 27 (56%) were Saudi. The mean age was 43 years (43 ± 10 years). Twenty-four (50%) had genotype-4, and 26 (54%) had liver biopsy. The overall SVR rate was 75% (36/48) and was 83.3% (20/24) among genotype-4 patients. Baseline factors associated with SVR identified by univariate logistic regression were genotype-4 and early viral response (EVR), defined as a drop of ≥2 log in serum HCV viral load after 12 weeks of initiation of combination therapy (P = 0.001). However, in stepwise regression analysis, the independent factor associated with the effect of antiviral therapy was genotype-4. When on-treatment variables were included, EVR (P = 0.003) and low baseline viral load (P = 0.048) were highly predictive of SVR. Conclusions: Of our HCV-treated patients, 75% had SVR. HCV genotype-4, EVR, and low baseline viral load were predictive of SVR.
  17 3,437 372
BRIEF REPORTS
Fortification with vitamin D: Comparative study in the Saudi Arabian and US markets
Mir Sadat-Ali, Abdulmohsen Al Elq, Mohammed Al-Farhan, Nazia A Sadat
January-April 2013, 20(1):49-52
DOI:10.4103/2230-8229.108186  PMID:23723731
Background and Objective: Vitamin D deficiency is common among Saudi Arabian population. To evaluate the current status of vitamin D fortification and calcium content of commonly consumed food items by the Saudi population and to compare it to US data. Setting and Design: Cross-sectional market survey at markets of Eastern Province of Saudi Arabia and State of Illinois, USA. Methods: A dietary survey was carried out for the content of calcium and vitamin D on the most commonly consumed food products by the Saudi population which are suppose to be fortified by vitamin D. The survey included different brands of fresh milk, yoghurt, powdered milk, cheese, ready-to-eat breakfast cereals and orange juice. Vitamin D content in the products studied from the Saudi marketplace was compared with the suggested vitamin D content in the same products according to US Code of Federal Regulations recommendations. Results: The overall calcium content in the processed dairy products is generally higher than the content in fresh dairy products. Vitamin D content in the fresh dairy products varied from 40 IU/L to 400 IU/L. None of the cereals or orange juice in Saudi Arabia contain vitamin D supplement. The vitamin D content in the food items from the Saudi marketplace is mostly lower than recommended by the US Code of Federal Regulations. Conclusion: Most commonly consumed food products by Saudi population which are suppose to be fortified by vitamin D either not fortified or contain an amount less than recommended by guidelines set for US marketplace.
  15 4,249 428
ORIGINAL ARTICLES
Prevalence study of oral mucosal lesions, mucosal variants, and treatment required for patients reporting to a dental school in North India: In accordance with WHO guidelines
Puneet Bhatnagar, Shalu Rai, Gunjan Bhatnagar, Mandeep Kaur, Sumit Goel, Mukul Prabhat
January-April 2013, 20(1):41-48
DOI:10.4103/2230-8229.108183  PMID:23723730
The aim of the study was to evaluate the prevalence of oral mucosal lesions (OML) in adult patients reporting to the dental outpatient department at the Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India. The purpose was to determine the priorities in oral health education, preventive measures, and identify the group in urgent need of treatment. Materials and Methods: The study was conducted over a period of 6 months in 2010, when 8866 subjects were offered structured interviews and standardized extraoral and intraoral examinations according to the World Health Organization (WHO) guidelines . Result: Overall prevalence of OML was 1736 (16.8%), the most prevalent being smoker's palate (10.44%) followed by leukoplakia (2.83%), oral submucous fibrosis (1.97%), oral candidiasis (1.61%), recurrent aphthous stomatitis (1.53%), oral lichen planus (0.8%) and others (0.78%). The highest prevalence of the tobacco habit in both forms was recorded in the group aged 40-44 yearsand those aged between 60 and 64 years who wore dentures. Lesions were most prevalent in those aged 40-44 years with a significant predominance of males at 3:1 (M = 12.6% and F = 4.3%). Patients who consumed tobacco in any form or wore dentures had a significantly higher prevalence of OML (P < 0.001). The highest number of lesions were on the palate (59.7%) followed by buccal mucosa (19.9%). Various normal mucosal variants were recorded. Fordyce's granules (0.13%), fissured tongue (3.3%), leukoedema (1.47%), and lingual varices (2.73%) were also recorded. The tongue showed the highest number of variants (64.4%). Patients were grouped according to the treatment needed under the WHO criteria. One hundred and ninety-seven patients were given oral hygiene instructions only, whereas 1422 patients were advised on change of habit and a follow-up and 674 patients needed definitive treatment. Conclusion: This study thus highlights diagnostic criteria, multifactorial risk factors to make standard measurements of OML a basis for planning and evaluating oral health programs for data collection.
  15 4,767 758
BRIEF REPORTS
Profile of morbidity among elderly at home health care service in Southern Saudi Arabia
Mohamed A Al-Modeer, Noha S Hassanien, Chauky M Jabloun
January-April 2013, 20(1):53-57
DOI:10.4103/2230-8229.108187  PMID:23723732
Background: This study aimed to determine the profile of morbidity among elderly registered at home health care service in the Armed Forces Hospital of Southern Region, Kingdom of Saudi Arabia. Materials and Methods: A retrospective study was conducted (over a period of 6 months during year 2011) and data was collected by reviewing of medical records of all elderly patients of elderly. Results: The total number of elderly ≥ 60 years were 880. The most prevalent morbidity is hypertension (59.1%) followed by diabetes mellitus (57.3%), stroke (34.9%), dementia (28.5%), osteoarthritis (24.2%) and Alzheimer (21.4%). Females are at higher risks of having many types elderly diseases compared to males. The highest risk was for obesity (OR = 9.1; 95% CI = 3.51- 12.8), followed by osteoporosis (OR = 8.7; 95% CI = 15.10 - 9.13) and fracture neck femur (OR = 3.9; 95 CI = 2.11 - 6.91). In addition, females were also at higher risks of having Osteoarthritis and thyroid disorder. On the other hand, males are more susceptible to hypertension (OR = 1.4; 95 % CI = 1.07 - 1.85), stroke (OR = 1.3; 95 % CI = 1.08 - 1.89) and renal diseases (OR = 2.4; 95% CI = 1.25 - 4.54). Conclusion: It is concluded that there is a great need for preventive, curative and rehabilitative program in order to introduce high quality of health care services to elderly.
  11 3,446 505
ORIGINAL ARTICLES
Maternal complications and neonatal outcome in Arab women of a fast developing country
Abdulbari Bener, Mohammed Al-Nufal, Pankit J Vachhani, Awab I Ali, Nancy Samson, Najah M Saleh
January-April 2013, 20(1):27-34
DOI:10.4103/2230-8229.108181  PMID:23723728
Objective: The objective of the study was to examine maternal complications that occur during the third trimester and their neonatal outcome in Arab women residing in Qatar. Design : This is a prospective hospital-based study. Setting: The survey was carried out in women's hospital. Materials and Methods: The study was based on the log book of the women's hospital, from which we recruited women in their third trimester of pregnancy between the first week of January 2010 and April 2011. Of the 1 824 Arab women who were approached to participate in the study, 1 432 (78.5%) consented. Face-to-face interviews were conducted with the pregnant women in the third trimester attending routine antenatal clinics at a women's hospital. The questionnaire covered variables related to sociodemographic factors, family history, medical history, maternal complications, and neonatal outcome. Medical records of the patients were referred to collect the clinical variables. Results: Of the pregnant women studied, 39.8% were less than 30 years of age. The risk of maternal complications was higher in housewives (60.8%) and women with a low monthly household income (38.2%). Most of the pregnant women (77.6%) had antenatal care. Normal delivery (69.7%) was more common in expatriate Arab women, whereas caesarean was more prevalent in Qatari women (22.2%). Women aged 35 years or older had a significantly higher risk of maternal complications such as gestational diabetes (20.8% vs 13.4%; P < 0.01), gestational hypertension (21.6% vs 15.2%; P = 0.003), and ante-partum hemorrhage (17.9% vs 13.7%; P = 0.042) than younger women. Gestational diabetes increased the risk of caesarean delivery (25.1%) and macrosomia (42.3%). The frequency of caesarean delivery (22.1%) was higher in women with gestational hypertension. Neonatal complications such as Apgar score (<7) 1 minute (33.1% vs 21.2%; P < 0.001), 5 minutes (13.1% vs 8.2%; P = 0.005), and congenital anomalies (2.9% vs 0.9%; P = 0.007) were significantly higher in newborns of older women. Low birth weight (11.1%) and Apgar 1 st minute < 7 rate (28.2%) were higher in newborns of mothers with ante-partum hemorrhage. Conclusion: The study findings revealed that maternal complications such as gestational diabetes, gestational hypertension, ante-partum hemorrhage, and maternal anemia were significantly higher in older pregnant women. Similarly, neonatal complications were higher in the newborns of older women. Gestational hypertension was the leading maternal complication observed in Arab women.
  6 4,204 765
Family biosocial variables influencing the use of insecticide treated nets for children in Eastern Nigeria
Gabriel U. P. Iloh, Agwu N Amadi, Charles E Obiukwu, Patrick U Njoku, John N Ofoedu, Godwin O. C. Okafor
January-April 2013, 20(1):12-19
DOI:10.4103/2230-8229.108178  PMID:23723726
Background: Effective reduction of malaria morbidity and mortality in Nigerian children under the age of five depends to a large extent on family biosocial factors. Although, the awareness of insecticide treated bed nets (ITNs) is reportedly high and increasing in Nigeria there remain large gaps between awareness, possession and use by families with children under the age of five in Nigeria. Aim: To determine the family biosocial variables that influence the use of insecticide treated nets for children in Eastern Nigeria. Materials and Methods: A descriptive hospital-based study was carried out from June 2008-June 2011 on a cross-section of 415 mothers with children under the age of five, who were treated for confirmed malaria, and met the selection criteria were interviewed using a pretested, structured researcher-administered questionnaire. The questionnaire tool elicited information on family socio-demographic variables, inter-spousal discussion, communication, concurrence and participation in the use of insecticide treated bed nets; and reasons for non-utilization. The period of usage in the previous 6 months was assessed and graded using a scoring system of 0-4. Scores of 1-4 indicated usage while score of 0 meant non use. Results: The rate of ITNs use was 53.0%. The family variables that significantly influenced utilization were secondary education and above of parents (mother: P0 = 0.009; father: P = 0.001), monogamy (P value = 0.024), family size of 1-4 (P value = 0.016) and parents living together ( P = 0.001); others included parents' occupation (mother: P = 0.003; father: P = 0.04) and inter-spousal discussion (P value = 0.001), communication (P value = 0.001), concurrence ( P = 0.000) and participation ( P = 0.000). The commonest reason for non- use was inconvenience during sleep ( P = 0.04). Conclusion: This study shows that the rate of ITN use was marginally good. Specifically, this rate was significantly influenced by some family variables. The families of children under the age of five should, therefore, be the focus of intensive health promotion campaign to influence the use of ITNs to produce ITN family friendly communities.
  5 4,201 675
Study designs and statistical methods in the Journal of Family and Community Medicine: 1994-2010
Abdullah S Aljoudi
January-April 2013, 20(1):8-11
DOI:10.4103/2230-8229.108175  PMID:23723725
Introduction: The Journal of Family and Community Medicine (JFCM) is the official peer reviewed scientific publication of the Saudi Society of Family and Community Medicine. Unlike many peer medical journals, the contents of JFCM, have never been analyzed. The objective of this study was to perform an analysis of the contents of the JFCM over a 16-year period to discern the study designs and statistical methods used with a view to improving future contents of the journal. Materials and Methods: All volumes of the JFCM, from 1 January 1994 to 31 December 2010 were hand searched for research articles. All papers identified as original articles were selected. For every article, the study designs and the statistical methods used were recorded. Articles were then classified according to their statistical methods and study designs. The frequency of study designs was calculated as a simple percentage of the total number of articles, while the frequency of statistical methods was calculated as a percentage of articles that used those statistical methods. Results: A total of 229 articles were analyzed. Of these, 66 (28.8%) either reported no statistics or reported simple summaries. The cross-sectional design was used in 175 (76.4%) of all analyzed articles. Statistical methods were used in 163 (71.2%) articles. Chi-squared test was used in 111 (68.1%) articles, and t-test used in 48 (29.4%) articles. Other common statistical tests were: Regression, which was used in 35 (21.5%) articles, ANOVA used in 23 (14.1%) articles, and odds ratio and relative risk tests which were used in 22 (13.5%) articles. Conclusions: The JFCM has a wide range of study designs and statistical methods. However, no article on experimental studies has been published in the JFCM since its inception.
  1 3,824 753
SHORT COMMUNICATION
Skin infections in male pupils of primary schools in Al Ahsa
Montassar Amri, Tarek Amin, Waseem Sulaiman
January-April 2013, 20(1):58-62
DOI:10.4103/2230-8229.108189  PMID:23723733
Objectives: To determine the prevalence, the nature, and the possible socio-demographic risk factors involved in the development of common transmissible skin disorders (TSD) among the studied population. Materials and Methods: A cross-sectional consecutive survey was carried out from November 15, 2008 to May 14, 2009 in Al-Ahsa governorate. This study included 1337 male primary school children. Data were collected using the following tools: Socio-demographics and hygienic habits according to pre-established forms and a thorough dermatological examination of all the included children. Results: The prevalence of TSD was 27.15% with a statistically significant difference according to rural/urban locations (33.74% vs. 22.27%). Fungal infections were the leading diseases (9.1%) followed by bacterial infections (8.9%), parasitic infestations (4.3%), and viral infections (4.1%). TSD were significantly more frequent in students whose fathers have a primary or preparatory educational status and in the students having the habit to play barefooted. Conclusion: Our study found that TSD was relatively frequent among male primary school students in Al-Ahsa. Our study has several limitations. One major limitation is that female primary school students were excluded from the study. Despite this major limitation, we hope the findings may be useful in planning health care programs for Saudi children with the hope of reducing the prevalence of TSD in the future.
  - 2,315 278
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Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010