Determinants of the Underlying Causes of Mortality during the First Wave of COVID-19 Pandemic in Saudi Arabia: A Descriptive National Study

Validating the diagnostic accuracy of medical certification: a population-level comparison between verbal autopsy and Saudi medical records causes of death of deceased with type 2 diabetes

BACKGROUND

In contexts where certifying causes of death (COD) is inadequate - either in industrialized or non-industrialized countries - verbal autopsy (VA) serves as a practical method for determining probable COD, helping to address gaps in vital data.

OBJECTIVE

This study aimed to validate the diagnostic accuracy of medical certifications at a population level by comparing COD obtained from medical records against those derived from VA in Saudi Arabia.

METHOD

Death records from 2018 to 2021 were collected from a type 2 diabetes mellitus register at a major specialist hospital in Makkah. Three hundred and two VA interviews were completed with deceased patients' relatives, and the probable COD was determined using InterVA-5 software. Lin's concordance correlation coefficient was applied to examine similarities of the cause-specific mortality fractions (CSMFs) based on International Classification of Diseases chapters from both verbal autopsy causes of death (VACOD) and the physician review causes of death (PRCOD).

RESULTS

Overall, the findings demonstrated a moderate level of concordance of COD at the population between VACOD and PRCOD. However, the CSMFs for various COD categories derived from both sources showed a broad spectrum of absolute differences, with the largest disparities observed among the most prevalent COD categories.

CONCLUSION

PRCOD was found to overestimate population-level endocrine/metabolic and respiratory disease COD while underestimating circulatory disease, demonstrating medical certification challenges. Conversely, affirming previous literature on prevalent COD in Saudi Arabia, VA appears to deliver a plausible assessment, further strengthening its potential to integrate within the Saudi health system towards an augmented medical certification process.

Social and health system barriers: Investigating Circumstances of Mortality Categories (COMCATs) for deceased patients with T2DM in the sub-national Saudi Arabia register

Health policy debates rely on reliable and timely information on major causes of mortality and their associated attributors, especially to overcome the traditional public health focus restricted to the biomedical cause of death (COD). This study explores relevant social and health system circumstantial barriers to accessing healthcare services among deceased patients with Type 2 Diabetes Mellitus (T2DM) in Saudi Arabia. A total of 302 verbal autopsy (VA) interviews were conducted with relatives or caregivers of the deceased who died between 2018 and 2021, based on T2DM medical records from Alnoor Specialist Hospital in the Western Province, Saudi Arabia. The Bayesian-based InterVA-5 algorithm was employed as a validated source to determine the probable COD and Circumstances Of Mortality Categories (COMCATs) for each case. COMCATs stand for predetermined categories of multiple social and healthcare system circumstances that contribute to an individual's death. The likelihoods of COD and COMCATs derived from InterVA-5 software were computed independently to generate the 'cause-specific mortality fractions' (CSMFs) of the COD and COMCATs. The CSMFs for the seven COMCATs categories were then ranked based on their derived probabilities for the corresponding COMCATs across all major COD categories. The top CODs were circulatory diseases (35.8%), stroke (16.6%), and diabetes mellitus (14.3%). The probabilities of COMCATs indicated that most deaths were attributed to 'inevitable' causes (e.g., terminal illness), followed by 'recognition' (inability to recognize the severity of illness) and 'traditions' (local attitudes deterring patients from seeking medical services on time). Addressing 'recognition' and 'traditions' barriers could reduce mortality rates and improve access to healthcare, helping the Saudi health system accelerate the progress towards the systematic measurement of key universal health coverage indicators. The study emphasizes the need for a robust and standardized VA method within routine medical services to address factors influencing healthcare access towards improved health outcomes.

The Validity of the Original and the Saudi-Modified Screening Tools for the Assessment of Malnutrition in Pediatrics: A Cross-Sectional Study

Background: Screening for malnutrition among hospitalized children is essential, and the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) is a validated tool for this purpose. The study aimed to modify STAMP for a Saudi context and assess the sensitivity and specificity of both the original and modified tools. Method: A cross-sectional study was conducted among 307 hospitalized children, where both the original and Saudi-modified STAMP were applied. Anthropometric measurements were also recorded, and statistical analysis using SPSS and validity parameters was used to assess the tools' validity. Results: The Saudi-modified STAMP identified a higher percentage of children at high risk of malnutrition compared to the original STAMP (91.6% vs. 62.9%). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and agreement of the Saudi-modified STAMP compared to the original were 94.3%, 13.2%, 64.8%, 57.7%, 0.654, and 0.089, respectively. Conclusions: The Saudi-modified STAMP showed excellent sensitivity and varied negative predictive value, indicating its potential effectiveness in screening for the risk of malnutrition among hospitalized children compared to the original STAMP.

Community perception of causes of death using verbal autopsy for diabetes mellitus in Saudi Arabia

Diabetes mellitus is a serious global health issue which significantly impacts public health and socioeconomic development. Exploring how the community perceives the causes of death and their associated risk factors is crucial for public health. This study combines verbal autopsy (VA) with the Type 2 Diabetes Mellitus (T2DM) register to explore community perceptions of causes of death and associated influential factors in Makkah province, Saudi Arabia. 302 VA interviews were conducted with relatives or caregivers of deceased who died between 2018 and 2021 based on T2DM medical register from Alnoor Specialist Hospital in Makkah City, Saudi Arabia. Cause-specific mortality fractions (CSMFs) obtained from the VA using the InterVA-5 model were utilized to assess community perception. We used a multivariable logistic regression model to determine factors influencing community perceptions of causes of death. Lin's CCC with 95% CI was used to analyze the concordance for the CSMFs from verbal autopsy causes of death (VACoD) as a presumed reference standard and family-reported causes of death (FRCoD). The outcomes of this study demonstrate a generally broad spectrum of community perceived mortalities, with some critical misconceptions based on the type of death and other vital events like marital status, with an overall CCC of 0.60 (95% CI: 0.20-1.00; p = 003). The study findings demonstrate that community perception is weak if the deceased was male compared to female (aOR: 0.52; 95% CI: 0.26-1.03) and if the deceased was > = 80 years compared to 34-59 years (aOR: 0.48; 95% CI: 0.16-1.38), but it significantly improves among married compared to single (aOR: 2.13; 95% CI: 1.02-4.42). Exploring community perception of causes of death is crucial as it provides valuable insights into the community's understanding, beliefs, and concerns regarding mortality. Higher or lower community perception is attributed to how people may perceive risk factors associated with the causes of death, which can guide public health planning and interventional programs. The study findings further emphasize the need to employ robust and standardized VA methods within the routine medical services for a systemized assessment of families' reported causes of death.

Amer S. Determinants of Healthy Food Consumption and the Effect of Saudi Food Related Policies on the Adult Saudi Population, a National Descriptive Assessment 2019

Saudi Arabia (SA) is a country with an advanced nutritional transition, so this study aims to measure the prevalence of healthy food consumption and its context, and to study the effect of Saudi Arabia's policies on the pattern of food consumption among inhabitants in SA. Through an online self-administered and validated questionnaire, the cross-sectional study recruited 590 randomly chosen adult Saudis who were stratified to represent the 20 health regions in KSA. Ethical approval was obtained for this work. The relevant tests were used to code and analyze the collected data. Of the 590 participants, 50.2% were males, with a mean ± SD age of 35.6±10.52 year.43.2% of the participants did not meet the Ministry of Health recommendation in any food group, while only 1.53% consumed the recommended amounts of all food groups. 47.8% of the participants did not perform any physical activity. 34.7% of participants prefer healthy food, 18.8% prefer unhealthy food, and 46.5% prefer both. Most Saudis do not comply with the national dietary guidelines’ recommendations, they are physically inactive, and they use social media in a way that affects their food choices.

Prevalence and Determinants of Mobile Health Applications Usage: A National Descriptive Study

We aimed to determine the prevalence of MHAs' usage and explore the context and determinants of using MHAs among inhabitants in Saudi Arabia (SA). This cross-sectional study randomly selected 679 adult inhabitants from the 20 health regions in SA through an electronic, self-administered, well-structured, and validated Arabic questionnaire. The prevalence of using MHAs was 47.9%, and it was significantly higher among younger, Saudis, highly educated, and working participants, as well as those with chronic diseases (p < 0.05). The main motives for using MHAs were to promote health status (68.6%) and to lose weight (33.2%). The most used apps were related to daily steps-counting (54.2%), and among females was tracking ovulation period apps (43.5%). The most common reported advantage of using MHAs was saving time (64%). Despite the potential benefits of MHAs, they were used by only about half of the study participants in SA. The most effective MHAs in improving health status were exercise, calorie-related, water uptake, and daily steps-counting apps. Policymakers looking to address reform aimed at improving health with mobile apps will find our study interesting.