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More than a decade after the World Health Organization Commission on the Social Determinants of Health (SDoH), it is becoming widely accepted that social and economic factors, including but not limited to education, energy, income, race, ethnicity, and housing, are important drivers of health in populations. Despite this understanding, in most contexts, social determinants are not central to local, national, or global decision-making. Greater clarity in conceptualizing social determinants, and more specificity in measuring them, can move us forward towards better incorporating social determinants in decision-making for health. In this paper, first, we summarize the evolution of the social framing of health. Second, we describe how the social determinants are conceptualized and contextualized differently at the global, national, and local levels. With this, we seek to demonstrate the importance of analyzing and understanding SDoH relative to the contexts in which they are experienced. Third, we problematize the gap in data across contexts on different dimensions of social determinants and describe data that could be curated to better understand the influence of social determinants at the local and national levels. Fourth, we describe the necessity of using data to understand social determinants and inform decision-making to improve health. Our overall goal is to provide a path for our collective understanding of the foundational causes of health, facilitated by advances in data access and quality, and realized through improved decision-making.

Objective: This study aimed to assess the knowledge, attitude, and training of health-care workers (HCW), and their perception of the preparedness of hospitals for communicable disease (CD) threats during mass gathering (MG) events. Methods: This was a cross-sectional study conducted from June 1 to July 31, 2019, of doctors and registered nurses working in the emergency departments (EDs) of 5 main hospitals in Qatar. A self-administered online survey was used for data collection. Results: The overall mean knowledge score about CD threat among study participants was 75.0% (SD ± 18.1). The majority of the participants had a favorable attitude toward CD preparedness during MG events. The participants achieved high scores in attending workshops on triaging, first aid, and infection control. Study participants as well had favorable perceptions about the current preparedness of their respective hospitals to respond to CD outbreaks in MG events. Conclusions: The participants were knowledgeable about the risk of CD outbreaks during MG events (eg, Federation of International Football Association (FIFA) World Cup games 2022) and had a favorable attitude and necessary training to respond to such outbreaks. Regular practice drills are necessary to ensure that all members of the workforce are knowledgeable of the necessary actions to take in emergent high-risk situations.

A new design for a silicon-on-insulator (SOI) optical biosensor is proposed in the form of a hybrid double-ring resonator. The proposed device improves the sensitivity by 2.4 times compared with the traditional devices.

In 2010, Qatar adopted the target of reducing hepatitis B prevalence to1% in children by 2015. The World Health Organization Region for the Eastern Mediterranean is identified with intermediate hepatitis B virus (HBV) endemicity, ranging from 2% to 7%. It is estimated that 4.3 million individuals are living with HBV infection in the Region.This study was conducted to assess hepatitis B seroprevalence in children, hepatitis B vaccination coverage, potential exposure to risk factors, and knowledge among parents/guardians about hepatitis B infection.We carried out this cross-sectional study in Qatar during the academic year 2015/16. Multistage cluster sampling was used to select a nationally representative sample of 2735 grade 1 school students aged ≥ 5 years. Blood was collected by finger prick and tested using the point-of-care test/rapid test. A self-administered, precoded questionnaire was used to assess parent/guardian knowledge about HBV and collect information on the child's HBV vaccination coverage.All blood samples were HBsAg negative. Qataris had a vaccination card and were totally vaccinated but 17.7% of non-Qataris did not hold a vaccination card and most parents/guardians were not aware of the vaccination status of their children. Children were exposed to various hepatitis B risk practices. Knowledge about hepatitis B among parents/ guardians was low.Qatar has averted the hepatitis B threat and maintained high vaccination coverage for children.تقييم برنامج تطعيم طلاب المدارس ضد التهاب الكبد B في قطر.حمد الرميحي، هناء المصري، شيرين شوقي، محمد آل ثاني، صلاح العويدي، محمد أحمد جناحي، معتز دربالة، خالد الأنصاري، روبرت أليسون.في عام 2010 ، تَبَنَّت قطر هدف خفض معدل انتشار فيروس التهاب الكبد B إلى أقل من 1% لدى الأطفال بحلول عام 2015. ولقد قدر استيطان فيروس التهاب الكبد B بإقليم شرق المتوسط في منظمة الصحة العالمية بدرجة متوسطة، لأن معدل انتشاره يتراوح بين 2% و 7%. وتشير التقديرات إلى أن 4.3 مليون شخص يعيشون مع العدوى بفيروس التهاب الكبد B في الإقليم.أجريت هذه الدراسة لتقييم معدل الانتشار المصلي لفيروس التهاب الكبد B لدى الأطفال، والتغطية بالتطعيم ضد التهاب الكبد B، والتعرُّض المحتمل لعوامل الخطر، ومعرفة الآباء/الأوصياء بعدوى التهاب الكبد B.لقد أجرينا هذه الدراسة المقطعية في قطر خلال العام الدراسي 2015/2016 ، واستخدمنا العينة العنقودية المتعددة المراحل لاختيار عينة ممثلة على الصعيد الوطني تضم 2735 طالباً في الصف الأول من المدرسة بعمر 5 سنوات وأكثر، وجمعنا الدم بوخز الإصبع وفحصناه بالاختبار السريع/اختبار نقطة الرعاية، واستخدمنا الاستبيان الذي يُدار ذاتيًا، والذي أعددنا رموزه مسبقاً، لتقييم معرفة الآباء/الأوصياء عن فيروس التهاب الكبد B، وجمعنا المعلومات حول التغطية بالتطعيم ضد فيروس التهاب الكبد B.كانت جميع عينات الدم سلبية للمستضد السطحي لفيروس التهاب الكبد B HBsAg، وكان لدى القطريين المشاركين بالدراسة بطاقات تطعيم وتم تطعيمهم بالكامل، لكن 17.7 % من المشاركين بالدراسة من غير القطريين لم يحملوا بطاقة تطعيم، ولم يكن معظم آبائهم/الأوصياء عليهم على علم بحالة التطعيم لأطفالهم، مما يعرّض الأطفال لمخاطر متعددة لممارسات تنقل العدوى بالتهاب الكبد B. فقد كانت معرفة الآباء/ الأوصياء بالتهاب الكبد B منخفضة.لقد تفادت قطر تهديد التهاب الكبد B وحافظت على تغطية عالية لتطعيم الأطفال ضده.Évaluation d’un programme de vaccination contre l’hépatite B parmi des élèves au Qatar.En 2010, le Qatar a adopté une cible consistant à réduire la prévalence de l’hépatite B à moins de 1 % chez l’enfant d’ici 2015. La Région OMS de la Méditerranée orientale a été identifiée comme une région d’endémicité intermédiaire pour le virus de l’hépatite B, avec un taux compris entre 2 et 7 %. On estime que 4,3 millions de personnes dans la Région vivent avec une infection par le virus de l’hépatite B.La présente étude a été menée dans le but d’évaluer la séroprévalence de l’hépatite B chez l’enfant, la couverture vaccinale associée, le risque d’exposition aux facteurs de risque, et la connaissance de l’infection par le virus de l’hépatite B parmi les parents/tuteurs.La présente étude transversale a été réalisée au Qatar pendant l’année scolaire 2015-2016. L’échantillonnage en grappe à plusieurs niveaux a été la technique utilisée pour sélectionner un échantillon national représentatif de 2735 élèves de première année du primaire, âgés de cinq ans ou plus. Un prélèvement de sang a été réalisé par piqûre au doigt et un dépistage a été effectué à l’aide d’un test sur le lieu de soins/test rapide. Un questionnaire auto-administré précodé a été utilisé pour évaluer les connaissances des parents/tuteurs en matière d’hépatite B et recueillir des informations sur la couverture vaccinale des enfants contre l’hépatite B.Tous les échantillons sanguins étaient négatifs pour l’antigène de surface du virus de l’hépatite B. Les Qataris possédaient un carnet de vaccination et étaient complètement vaccinés, mais 17,7 % des non-Qataris ne possédaient pas de carnet de vaccination et la plupart des parents/tuteurs ne connaissaient pas le statut vaccinal de leurs enfants. Les enfants étaient exposés à différentes pratiques à risque pour l’hépatite B. Les connaissances des parents/tuteurs sur l’hépatite B étaient faibles.Le Qatar a su écarter la menace de l’hépatite B et maintenir une couverture vaccinale élevée pour les enfants.

Background: Hepatitis C viral infection is a public health concern worldwide and a major cause of morbidity and mortality in several countries that supply the State of Qatar with many of its laborers. The objectives were to measure the prevalence of hepatitis C viral infection among single male laborers; detect the practices that may catalyze the spread of the infection; and assess the knowledge gap. Methods: A cross-sectional study was conducted in 2014 and involved 504 expatriate single male laborers seeking health care in two Qatar Red Crescent health centers. Results: Results showed that only 5% of the total participants have ever been tested for hepatitis C and positive serology was detected in 4 respondents (0.8%), three of them from Egypt and one from Nepal. Three out of the 4 positive cases did not know they were infected and 2.5% lived with someone harboring the infection. Respondents appeared to have varying healthcare needs with 57% subject to medical procedures outside Qatar. Various risk practices for hepatitis C infection were reported including ear/body piercing (21.9%), tattooing (13.3%), contact with blood (17.0%), sharing personal equipment (12.2%) and injecting with used needles or syringes (7.4%). Less than 40% of respondents had knowledge of all modes of hepatitis C transmission. Conclusion: Further actions notably building HCV monitoring system, setting a prevention plan, building screening strategy were need to be complemented by a contract renewal or a 3-year screening policy.

OBJECTIVE: To measure HIV prevalence and related risk behaviors among male injection drug users (IDUs) in Cairo Egypt in the context of the first survey wave of an integrated biological and behavioral surveillance system. DESIGN AND METHODS: Given the hidden nature of injection drug use we used the peer-referral methodology of respondent-driven sampling in a cross-sectional study to recruit a sample of male IDUs in Cairo between May and August 2006. Behavioral data were collected through face-to-face interviews and serum was obtained for HIV antibody testing. Population estimates were produced using respondent-driven sampling Analysis Tool. RESULTS: The study enrolled 413 male IDUs. The population estimated HIV prevalence was 0.6% (95% confidence interval 0.1-1.8). More than half (53.0%) reported injecting drugs with used needles or syringes and nearly one-third (32.4%) shared their used needle or syringe with one or more persons in the preceding month. Overall 70.5% had sex in the preceding year of whom 9.4% reported sex with male partners and 13.2% reported sex with commercial sex workers in the preceding 12 months. Ever use of a condom during sex was low with all partner types and only 5.8% ever had an HIV test. CONCLUSION: This first survey wave of integrated biological and behavioral surveillance system in Egypt to track the HIV epidemic among male IDUs found relatively low prevalence of infection compared to global estimates though the figure is many times higher than the general population. In addition risky injection practices and unprotected sex were high with sexual networks including men who have sex with men female sex workers wives and other regular and casual partners. The respondent-driven sampling method was effective in recruiting male IDUs and the results are being used to inform surveillance and prevention programs.

The current health insurance system in Egypt targets the productive population through an employment-based scheme bounded by a cost ceiling and focusing on curative care. Egypt Social Contract Survey data from 2005 were used to evaluate the impact of the employment-based scheme on health system accessibility and financing. Only 22.8% of the population in the productive age range (19-59 years) benefited from any health insurance scheme. The employment-based scheme covered 39.3% of the working population and was skewed towards urban areas, older people, females and the wealthier. It did not increase service utilization, but reduced out-of-pocket expenditure. Egypt should blend all health insurance schemes and adopt an innovative approach to reach universal coverage.

HIV infection is the most devastating infection that has emerged in the recent history. The risk of being infected can be associated with both individual's knowledge and behavior and community vulnerability influenced by cultural norms, laws, politics, and social practices. Despite that the countries in the Middle East and North Africa have succeeded in keeping low the HIV epidemic rates, the number of identified infected cases are increasing. Since the appearance of the first AIDS cases, all the national authorities devoted their efforts to abort the epidemic in its early stages. The rate of new HIV infections across the Middle East and North Africa region are not at an alarming level, but the need for a concerted effort from nation-states and nongovernmental organizations to stem the spread of the virus across the region is vital.Most countries of the region have put in place better information systems to track the HIV epidemic, yet the passive HIV/AIDS reporting remains the cornerstone in the HIV surveillance systems. Several countries still believe that their current strategies are optimal to the HIV status within their territories and that their national strategies are appropriate to their low epidemic status that is not expected to grow. Additionally, these countries fear that establishing an HIV national program to survey risk behaviors may be perceived as an approval of these behaviors that are culturally and religiously unacceptable. This background article aims to summarize the HIV surveillance strategies and epidemic profile in 17 Arab countries in the Middle East and North Africa. The article, also, displays the national surveillance system and the epidemic profile in Egypt and Lebanon as models for the region. This information aims to provide useful insights that may help the national authorities in finding out the best surveillance strategies that allow merging and collecting biological and risk data which is an integral part of their efforts to fight the HIV epidemic in the region.

Introduction: Adolescence is an important period in an individual’s life. Overweight and obesity are fraught with several health problems even later in life. The objective of this study was to estimate the overweight, obesity, body fat and muscle content of Saudi adolescents as compared to a recognized reference population. Subjects and Methods: Data were collected from a sample of Saudi adolescents in Jeddah from 42 boys’ and 42 girls’ schools during the month of April 2000. Data collection was done by personal interviews to collect sociodemographic factors and by direct measurement of weight, height, triceps skin fold thickness (TSF) and mid-arm circumference (MAC). The 50th, 85th, and 95th percentiles (P50, P85 and P95) for body mass index (BMI) and triceps skin fold thickness (TSF) were taken, then the 50th, 90th, and 95th percentiles (P50, P90 and P95) for the mid-arm muscle circumference (MAMC) were calculated. These measurements were compared with corresponding values of the National Health and Nutrition Examination Survey I (NHANES I). Results: The P85 and P95 for BMI and TSF were higher for Saudi adolescents than the NHANES I and the difference was wider for P95. Conversely, there was a lower MAMC at P90 and P95 than the NHANES I reference population curves. The lower MAMC curves were less marked in girls than in boys. On the other hand, Saudi boys and girls showed on average similar body mass index indicated by BMI at P50, which was misleading, since those adolescents showing similar body mass index had more fatness than the average reference population indicated by TSF at P50, and less muscularity on average than reference population indicated by MAMC at P50. Conclusion: Overweight and obesity with increased body fat content and decreased body muscle content appear to be widespread among Saudi adolescents even among those adolescents showing average body mass index. Public health interventions are required to improve quality of food, encourage physical activity and exercise, as well as correct the perception of appropriate body stature

There has been much debate about the use of depleted uranium in the Gulf War and its health effects on United States and European war veterans. However, studies on the impact of this radioactive substance on the residents of the surrounding Gulf region are far from adequate. Depleted uranium introduces large quantities of radioactive material that is hazardous to biological organisms, continues to decay for millennia and is able to travel tens of kilometres in air. If depleted uranium were used in the Gulf War, its impact on the health of people in the area would have been considerable. This review of depleted uranium-its origin, properties, uses and effects on the human environment and health-aims to trigger further research on this subject.

Childhood disability is a major health problem that is pronounced in developing countries. The objectives of this study were to identify the maternal risk factors present in our society and their impact on acquiring a disabled child. Data were collected from the six governmental rehabilitation institutes and a sample of normal non-disabled school children in Jeddah City. Information on sociodemographic factors and maternal risk factors was collected by in-person interview and copied from the children’s institute records. Logistic regression models were fitted to calculate the adjusted odds ratios in order to demonstrate the impact for the various maternal risk factors on having a disabled child. Our results have shown that certain modifiable maternal risk factors affecting child health still exist in our community such as early and late-age marriage and childbearing as well as low education unemployment multiparity and consanguineous marriages. All these risks were shown to put the mother at higher risk of having an auditory disabled child. Also older-age childbearing (>/= 30 years) low education level and multiparity were the maternal risk factors identified that influenced the risk of visual disability in children. Similar maternal risk factors in addition to unemployment were more observed among mothers of mentally disabled children. A huge effort is required to discourage the potential risk factors in our community that influence child health. (authors)

Background. A study was performed among university and school employees as a step in detecting the prevalence of coronary heart disease (CHD) risk factors among school and university staff and the relation of the various risk factors to hypercholesterolemia and to predict the 5-years probability of development of CHD. Methods. All university staff and a sample of school workers in Jeddah were included in the study. Data were collected by interview and self-administered questionnaires, as well as by direct observation and measurement of weight, height, blood pressure, and total blood cholesterol. Logistic regression analysis was performed to identify the impact of various risk factors on hypercholesterolemia. The 5-year risk of development of CHD was calculated to identify the proportion at highest risk. Results. Some CHD risk factors were detected among the participants as 18.8% were current cigarette smokers, around half were classified as overweight, and 19.9% were classified as hypertensive. Hypercholesterolemia was present in 10.1% and was significantly related to older age (40 years and over) and place of work. The estimated risk of CHD in the coming half-decade for those classified in the fifth quintile was 0.068. The Q5/Q1 ratio has shown that those classified in the fifth quintile were at 3.6 times more risk of developing CHD in the coming 5 years than those classified in the first quintile. Conclusion. CHD risk factors are becoming prevalent in our society. The risk of development of CHD in the coming decades is not trivial. Short- and long-term health strategies are recommended to decrease the risk of CHD and improve the quality of life.

A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a performance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other districts in Egypt.

Egyptian hepatocellular carcinoma (HCC) patients present at advanced stages. We aimed to study the influence of surveillance versus non-surveillance on HCC staging and the potential therapeutic options.A retrospective study to evaluate the effect of surveillance on early detection of HCC among cirrhotic patients from 2003 to 2008. Patients examined every 6 months using ultrasound and α-fetoprotein (α-FP) (group A) and those diagnosed with those that present for the first time symptomatically or incidentally (group B). Groups were compared for α-FP level, tumour characteristics, severity of liver disease; tumour staging was evaluated by Okuda, CLIP and BCLC staging systems, in addition to the potential therapeutic options.Group A comprised 122 HCC cases and group B 473. Surveillance improved HCC detection: at the stage of single nodule in 62.3% in group A versus 52.2% in group B, (P = 0.046) and reduced the percentage of HCC with portal vein thrombosis in 16.4 versus 33.8%, (P = 0.000) and the percentage of α-FP400 ng/ml in 19.5 versus 32.6%, (P = 0.006) in groups A and B, respectively. Surveillance doubled the detection of HCC at early stage of BCLC (25.4 vs. 11.9% P = 0.000) and doubled the patients' chance for loco-regional ablation (12.3 vs. 5.9%, P = 0.015) and liver transplantation (10.7 vs. 3.2%, P = 0.001) in groups A and B, respectively.HCC surveillance increases early detection of HCC and doubled the chances for curative options. Implementation of both HCC surveillance and cadaveric liver transplantation programs should be recommended in Egypt.

The celebration in Doha of the 30th anniversary of the Alma-Ata Declaration at the International Conference on Primary Health Care renewed the commitment of the Eastern Mediterranean Region to primary health care as the tool for better health. The principles agreed at Alma-Ata in 1978 apply as much now as they did before. The event provided an opportunity for the Eastern Mediterranean countries to define future directions to steer the health systems to integrate primary health care and harness the intersectoral approach.الرعاية الصحية الأولية في إقليم شرق المتوسط: من ألما آتا إلى الدوحةشيرين شوقيفي الاحتفال بالذكرى الثلاثين لإعلان ألما آتا في المؤتمر الدولي حول الرعاية الصحية الأولية الذي أقيم في الدوحة، تجدَّد التزام إقليم شرق المتوسط بالرعاية الصحية باعتبارها الوسيلة لتحقيق صحة أفضل. ولاتزال المبادئ التي حظيت بالاتفاق عليها في ألما آتا عام 1978 تَنْطَبق اليوم كما كانت من قبل. وقد قدَّم هذا المؤتمر فرصة لبلدان إقليم شرق المتوسط لتحديد التوجُّهات المستقبلية لتوجيه النظم الصحية نحو إدماج الرعاية الصحية الأولية، واتباع أسلوب العمل المتعدد القطاعات.Les soins de santé primaires dans la Région de la Méditerranée orientale : d’Alma-Ata à Doha.À l’occasion de la célébration à Doha du trentième anniversaire de la Déclaration d’Alma-Ata, lors de la Conférence internationale sur les soins de santé primaires, la Région de la Méditerranée orientale a renouvelé son engagement en faveur des soins de santé primaires en tant qu’outils pour l’amélioration de la santé. Les principes adoptés à Alma-Ata en 1978 restent, aujourd’hui comme hier, d’actualité. L’événement a fourni une occasion pour les pays de la Méditerranée orientale de convenir de nouvelles orientations pour guider les systèmes de santé, intégrer les soins de santé primaires et mettre en oeuvre l’approche intersectorielle.

A subgroup of HBeAg-negative chronic hepatitis B (CHB) patients with alanine aminotransferase (ALT) and/or hepatitis B virus (HBV)-DNA levels below the cutoff values of international guidelines may have significant liver disease and miss the opportunity for early treatment. Histopathological changes of HBeAg-negative CHB patients at initial presentation irrespective of HBV-DNA and/or ALT levels to increase the likelihood of patients for treatment are evaluated.CHB patients attending Cairo Liver Center from January 2006 to May 2008 had biochemical, serological, and virological screening as well as liver biopsy that was assessed by Metavir score.Fifty-two HBeAg-negative CHB patients (46 male and 6 female) with a median age of 37.5 years were included in the study. Significant fibrosis (or=F2) was found in 26% (5/19) of patients with serum HBV-DNA2,000 IU/ml, and 53% (21/40) of patients with ALT level2xULN. Liver biopsy increased candidacy for treatment by nearly 25% before implementation of the recommended lower ALT levels (30 U/l for male and 19 U/l for female patients), and by 21.2% after implementation of the lower ALT level. Implementation of the lower ALT level increased the candidacy of patients for treatment by 4% (two patients), whereas liver biopsy increased eligibility for treatment by 55.8 % (27/49).Liver biopsy is more reliable than either ALT or HBV-DNA levels in the decision to treat Egyptian HBeAg-negative CHB patients, even with the implementation of the recommended lower ALT levels.

The infant mortality rates for 1978 and 1998 of 16 Arab countries in the Eastern Mediterranean region were studied. The data were extracted from World Health Organization and United Nations Children’s Fund sources. The impact of demographic, social, perinatal care and economic indicators on infant mortality rates in 1998 was studied using Spearman rank coefficient to detect significant correlations. All countries, except Iraq, showed a sharp decline in rates from 1978 to 1998. Infant mortality rates were directly related to population size, annual total births, low birth weight and maternal mortality ratios. Also, infant mortality rates were inversely related to literacy status of both sexes, annual gross national product per capita and access to safe drinking-water and adequate sanitation facilities.

This paper aims to consider the available mortality data as an insight to epitomize the mortality pattern and the main leading causes of death specific to the Easter Mediterranean Region (EMR) in order to set priorities for future research in the region.Data was taken from the last 3 World Health Organization (WHO) mortality statistics. Crude mortality rates were compared between the 6 WHO regions for the years 1998, 1999 and 2000. Proportional mortality and standardized proportional mortality ratios were calculated for the causes of death and types of malignant neoplasm deaths and compared between the EMR and the other regions of the world. Spearman coefficient rank-order correlation was calculated to detect significant correlation between the ranking of the main causes of death in EMR and the 3 basic demographic, socio-economic and health care indicators in the 6 regions of the world.The results of this study showed that approximately 9 per 1,000 of the world's population die annually. Africa and Europe have the highest mortality rates. The main causes of death worldwide are cardiovascular diseases, infectious or parasitic diseases, malignant neoplasm, infectious respiratory diseases and other respiratory diseases. In EMR, approximately 8 per 1,000 die annually. The causes of death in EMR can be classified into 3 categories. 1) Non-prominent in EMR as compared to other regions of the world. 2) Prominent in EMR and significantly correlated to the basic indicators. 3) Prominent in EMR but not related to the basic indicators. These include deaths due to wars, congenital anomalies, perinatal conditions, genitourinary diseases, endocrine disorders, road traffic accidents, cancer bladder, lymphoma leukemiaThe results of this study emerged the need for extensive epidemiological studies to investigate thoroughly the main causes of death influencing mortality in EMR, specially that they coincide with the health consequences of depleted uranium. Also, most of these health conditions were previously described among the United States and European veterans who served in the Gulf War.

Iron deficiency anaemia is one of most prevalent nutritional disorders worldwide. It is known to affect the health and cognitive ability of children and adolescents. Studies in Saudi Arabia concentrate only on the population of young children and pregnant females or girls. Studies on the whole school student population is lacking. The objectives of this study were to identify the nutritional habits and the prevalence of anaemia among school students in Jeddah, as well as to recognize the students' awareness of their anaemic nutritional status. Data were collected from a sample of Saudi school children in Jeddah City from 42 boys' and 42 girls' schools during the month of April 2000. Data collection was done by an in-person interview to collect socio-demographic factors, nutritional habits, weight and height. Haemoglobin was measured in a sample of 800 students selected at random from both genders and different age groups. Anaemia was defined according to the new WHO cut-off levels for haemoglobin as: blood haemoglobin

Recently, there has been increasing concern about the decline in breast-feeding pattern in developing countries. The objectives of this study were to document the recent breast-feeding trends in Jeddah during the first year of an infant's life and identify the probable maternal risk factors implicated in breast-feeding cessation. Data were collected from six randomly selected primary health care centres in Jeddah City. All married women with an infant

To explore the relationship between self-reported weight and height to actual weight and height in a cross-sectional representative sample of school students in Jeddah City, Kingdom of Saudi Arabia and its relation to selected socio-economic and socio-demographic factors. Also to evaluate the validity of self-reported weight and height measurements.Data was collected from a sample of Saudi school students in Jeddah City, KSA from 42 boys' schools and 42 girls' schools during the month of April 2000. Data collection was carried out by an in-person interview to collect sociodemographic and self-reported weight and height, as well as, actual measurement of weight and height. Body mass index was classified according to age and genders into underweight (15th percentile), normal weight (=15th percentile to85th percentile), overweight (=85th percentile to95th percentile) and obesity (=95th percentile). Validity of self-reported obesity, as compared to measured body mass index, was assessed.A total of 2,860 Saudi school students were enrolled in the study with an age range from 9 to 21 years (mean=13.9, standard deviation=2.8). Overweight was reported in 13.4% and obesity in 13.5% of school students. Overweight and obesity were more marked among those of at least 13 years of age, male of high social class and students with highly educated mothers. Slightly above half of the school children were unaware of their weight and height giving an unknown body mass index in approximately 60% of cases. Among the remaining 40% who reported their weight and height, underestimation of weight was around 2.7 kg and was mainly among girls, in 16-21 year old group, high socio-economic class and born from educated mothers. Overestimation of height by 4 cm was reported mainly among the overweight, obese, girls, those with at least 16 years of age. Sensitivity of determining obesity by reported weight and height was low especially among girls and those of at least 16-years of age while specificity was more among boys than girls and improved by increase in age.Our results display the inaccuracy of self-reported weight and height in tracking obesity in our youth population. These results also emphasize the need for community and school based programs for preventing and reducing obesity in school age through improving the nutritional status awareness, diet habits and life style in order to ensure health and longevity.

The objectives of this study were to 1. assess the knowledge and attitude of the 5th year female medical students towards the objective structured examination in general and in Community Medicine in particular prior to the exam, 2. Detect any change in students' knowledge and attitude after passing the exam, 3. Identify the students' evaluation for future objective structured examination in Community Medicine and Primary Health Care and 4. Compare the students' performance in the objective structured examination in Community Medicine and Primary Health Care to the results of multiple choice questions evaluation in the department.There were 2 data sets, the first was collected by self-administered pre and post-objective structured examination questionnaires from all female medical students in the 5th year during the academic year 1996-1997 and the 2nd was copied from the students' results for objective structured examination and multiple choice questions in the department of Community Medicine and Primary Health Care during same academic year.All the 34 5th year female medical students were enrolled in the study. Most of them reported that they did not receive enough information prior to the objective structured examination and most of their knowledge came from side chats with friends or staff members which was confirmed by their weak knowledge and negative attitude towards the objective structured examination prior to the exam. After setting the objective structured examination, students' knowledge and attitude towards objective structured examination markedly improved and the majority displayed its advantage as an assessment tool and were convinced of its suitability for medical practice in general and community medicine in particular. Most students believed that objective structured examination in Community Medicine and Primary Health Care met their expectations and recommended it for the coming years. Also, students stated the negative and positive aspects that should be considered for future assessments. Moreover, the multiple choice questions were nearly similar and there was a significant correlation between both scores.The 5th year female medical students did not receive enough information and training on the objective structured examination which influenced their attitude prior to the exam. However, most of them showed a positive attitude after the experience and their marks in the objective structured examination were comparable to their marks in the multiple choice questions. The objective structured examination is a popular method of assessment in medical practice worldwide. The decision to discontinue its use after only one year did not allow space of time for evaluation of its appropriateness as an assessment tool. More research is recommended to study the main causes that lead to disregarding this type of medical assessment in the College of Medicine at King Abdulaziz University.

Childhood disability is a major health problem that is pronounced in developing countries. The objectives of this study were to identify the maternal risk factors present in our society and their impact on acquiring a disabled child. Data were collected from the six governmental rehabilitation institutes and a sample of normal non-disabled school children in Jeddah City. Information on sociodemographic factors and maternal risk factors was collected by in-person interview and copied from the children's institute records. Logistic regression models were fitted to calculate the adjusted odds ratios in order to demonstrate the impact for the various maternal risk factors on having a disabled child. Our results have shown that certain modifiable maternal risk factors affecting child health still exist in our community, such as early and late-age marriage and childbearing, as well as low education, unemployment, multiparity and consanguineous marriages. All these risks were shown to put the mother at higher risk of having an auditory disabled child. Also, older-age childbearing (or = 30 years), low education level and multiparity were the maternal risk factors identified that influenced the risk of visual disability in children. Similar maternal risk factors, in addition to unemployment, were more observed among mothers of mentally disabled children. A huge effort is required to discourage the potential risk factors in our community that influence child health.

The relationship between marriage before 16 years and pregnancy outcome throughout the childbearing period was examined. Participants included all married women attending six randomly selected primary health care units in Jeddah with at least one infant and complete medical files. Early teenage marriage was found for 27.2% of women. Most of these were illiterate [57.1%], housewives [92.4%]and grand multiparae [66.7%]. They were at twice the risk of spontaneous abortion, four times the risk of combined fetal death and infant mortality, and twice the risk of losing pregnancies any time during their childbearing years. They remained at high risk of poor pregnancy outcome throughout their reproductive lives. Despite tradition, marriage should be discouraged before 16 years

Background: The studies carried out on hepatocellular carcinoma (HCC) are scarce in Egypt. Nevertheless, they presumed an upward trend for HCC among chronic liver disease (CLD) patients. The objectives of this research were to determine the trend of HCC, the possible risk factors implicated in its development and the population attributable risk of HCVAb and HBsAg positivity for HCC. Methods: Medical records of all patients attending Cairo Liver Center during the years 1992-1995 were reviewed to determine the sociodemographic characteristics, HCVAb, HBsAg and HCC status. Prospectively, 200 HCC cases' stored sera as well as 120 healthy control were tested for aflatoxin B(1) quantitatively and qualitatively. Results: HCC accounted for 4.7% (321/6850) of CLD patients included in the study. HCVAb positive cases were strikingly high (71.1%) and HBsAg positive cases were reported in 22.4% of patients. There was an annual significant rise of HCC ranging from 3.6% in 1992 to 5.3% in 1995. HCC was significantly more prevalent among old age groups (60 years) than younger age groups. The impact of gender and past history of schistosomiasis on HCC was not proved by this study. HCVAb and HBsAg positivity were the two significant independent risk factors for HCC. The population attributable risk percent has shown that HCC cases attributed to HCVAb positivity accounted for 51.1%; while HBsAg positivity only explained 21.3% of cases. Aflatoxin B(1) was detected in 17% of HCC cases compared to 9.4% of healthy control. Risk ratio=2(95%). Conclusion: HCC is showing an increasing trend among our patients. Its development is mainly due to high rates of HCVAb and HBsAg positivity. HBsAg positive patients were at double risk to develop HCC and HCVAb positive patients were at 1.6 more risk. The high prevalence of HCVAb positivity renders its contribution to the development of HCC over seven-fold higher than HBsAg positivity. Short and long term health strategies are crucial to prevent and control HCC in Egypt.