The effects of a training program on knowledge, attitude and practice of the staff of primary health care centers towards growth monitoring: an intervention study

This study was carried out aiming at assessing the effects of a training program on the knowledge, attitude and practices (KAP) of health care workers (HCWs) in primary health care centers (PHCCs) regarding growth monitoring (GM). It included 148 health care workers (30 General Practitioners (GPs) and 118 nurses), from 17 PHCCs in Jeddah city, Kingdom of Saudi Arabia (KSA). Tests on KAP were held before and six months following a training program on GM conducted by the investigators. Results showed significant improvements in the KAP of the trained health care workers after training, the 44 trained HCWs obtained higher mean comprehension score (7.9 +/- 1.2), higher mean practice score (11.6 +/- 3.0), and higher mean general scores (32.3 +/- 4.6) compared to the mean scores they obtained in the pre-test (5.7 +/- 1.5; 7.4 +/- 2.2 and 25.7 +/- 4.4, respectively). These differences were statistically significant (P < 0.001). However; the difference in the mean knowledge scores, before and after the GM training program was not significant. The training has also led to the disappearance of the significant knowledge gap between GPs and nurses. And also, the 44 trained HCWs had higher mean comprehension score (7.9 +/- 1.2), mean practice score (11.6 +/- 3.0), and mean general scores (32.3 +/- 4.6) compared to those among untrained group (controls) (6.3 +/- 2.1; 8.5 +/- 3.7, and 27 +/- 6.1, respectively). These differences were statistically significant (P < 0.0005). Nevertheless, the difference in the mean knowledge scores, between the two groups, was not statistically significant. It also has led to some changes in the attitude of the trained HCWs towards GM compared to the untrained group. In conclusion, We credit the significant improvements in KAP of HCWs to the training program and recommend its adoption by the national MCH program in KSA. We also recommend new methods of teaching and training based on sound educational concept of active participation and practical work as well as supportive supervision and evaluation.

An outbreak of hepatitis A associated with treated waste water used for irrigation

Hepatitis A virus (HAV) infection is endemic in developing countries and remains a public health problem elsewhere. This study was conducted to investigate an outbreak of HAV infection, which occurred during a period of almost 5 months (January-May 1996) in the National Guard Iskan (Housing Authority) in Jeddah, Saudi Arabia. Ninety four cases were found to be positive for IgM antibody to HAV. A case control study was done to identify possible risk factors. For every case, 3 controls have been selected from the same household matched for age and sex. Information about reported cases was obtained by attending physicians through an interview questionnaire from adult cases and parents of young cases and controls (<12 y). It included questions regarding symptoms, demographics and possible source of the infection. Results showed that the attack rate of the whole population was 1.03 %, while that for children <10 years was twofold higher (2.05 %) than the total population. The risk of acquiring infection among them was found to be five times that among those aged 40 years and higher (R.R=5.32). There was a lack of association between developing hepatitis A and any of the food items or milk used in the studied area during the time of the outbreak. On the other hand exposure to irrigation water among cases was found to be significantly higher than among controls especially among children below 10 years (O.R=2.26). Analysis of the available data suggests a strong association between illness and exposure to waste water used for irrigation of gardens through playing with it, or through occasional drinking especially among children below 10 years. The prolonged course of the outbreak (5 months) may be attributed to subsequent person to person transmission from index cases to intimate contacts especially among the same household.

Ocular disorders among workers exposed to mercury

Mercury vapor exposed workers may show ocular changes, as well as other systems affection. A sample of 84 workers in preparing mercury fulminate were examined for conjunctival corneal and lenticular manifestation of long duration exposure, together with mercury urinary output. Lens changes were found in 50% of the involved workers while keratopathy as recorded in 34.5% of them. No statistically significant association was found between the occurrence of eye lesions and levels of urinary elimination of mercury. These results suggest local absorption of this element is most probably the underlying cause of ocular affection.

Impact of donor source on short-term outcome of renal transplantation in children

Renal transplantation is the ideal renal replacement therapy for children with endstage renal disease (ESRD). Follow-up of pediatric transplant recipients is tedious because of special problems like non-compliance to treatment and a very active immunological status. Twenty-five pediatric patients with ESRD who received kidney transplants in four different centers were followed up at the Jeddah Kidney Center, Saudi Arabia for a mean period of 22 months. The donor source for transplantation was as follows: living related (LR) in seven, cadaveric (CAD) and living unrelated (LUR) in nine patients each. The overall graft survival was 88% and patient survival 100% at the end of the follow-up period. Living related kidney recipients exhibited 100% graft survival at 22 months and also had the best kidney function. All the graft losses were due to irreversible rejection episodes. Medical complications were common and comprised of hypertension (82%), infection (52%) and rejection (44%). Recipients of LR donor kidneys had the lowest incidence of these complications. Surgical problems encountered were few and minor and needed only conservative management. In our experience, children having renal transplantation have an excellent outcome at short-term particularly with LR donors.

Residual renal function after living related kidney donation. Is it enough? An early report

The utilization of living's kidneys as renal replacement for Chronic Renal Failure (CRF) patients was debated for long time. However, the lack of renal pool in one hand and the proper employment of modern investigatory armamentarium in another hand could justify such donation. Living related donors (LRD) are subjected to extensive non invasive investigations to assess their general fitness for donation and split renal function. The impact of uni-nephrectomy on the renal function was studied in 25 LRD. Serum Creatinine (S. Cr.) Creatinine Clearance (Cr. Cl.) and renographic clearance tests for total and split renal function and renal volume using ultrasound were determined before and 3 months after donation. An initial increase in s.cr was seen in 76% of donors, but all levels are within normal range. Total kidney function by cr.cl showed significant drop by 36% of the pre donated value. Remaining kidney clearance increased by 5% to 64% with an average of 34% of the pre donated level as measured by Tc 99m DTPA renography. Following nephrectomy, compensatory hypertrophy of the remaining kidney attributed to an increase in the renal volume of 15%. In conclusion, kidney donation from living's is safe. Cr. clearance using the chemical method is a good screening test for potential LRD and for monitoring the renal function after donation. Renographic clearance using Tc 99m DTPA is as excellent useful test for split renal function in LRD work up. Long-term follow up might be needed.

Occupational dermatoses among workers in a porcelain manufacturing factory

The objectives of the present work are to determine the prevalence and risk factors of occurrence of occupational dermatoses among workers in a porcelain manufacturing factory. The study included 235 workers (132 males and 103 females). After history taking, dermatological examination was performed at the work place. Cases of contact dermatitis (CD) were patch tested using potassium dichromate 0.5%, Cobalt chloride 1% and Nickel sulphate 5% in petrolatum. Results showed that the prevalence of occupational dermatoses (OD) was 26.8% among exposed workers. The highest percentage of OD was found among workers in the decoration department. It represented 30.2% of all cases. CD was the commonest presentation among the studied group, it represented 27% of all cases of OD. Results of patch testing indicated that out of 17 cases of CD 12 cases (70%) were of the irritant variety and 5 cases (30%) were of the allergic type. The prevalence of OD was found to be affected by age, duration of work, type of exposure and daily bathing after work.

Cytogenetic study in workers occupationally exposed to mercury fulminate

This study was conducted to evaluate the cytogenetic effects in male workers exposed to mercury fulminate. A total of 29 male workers and 29 age- and sex-matched controls were examined. The mean mercury level in urine from the exposed workers was 123.2 +/- 54.1 micrograms/l compared with 39.2 +/- 11.1 micrograms/l in the control group. The difference was statistically significant (P less than 0.001). Metaphase chromosomes were studied. Micronucleated peripheral blood lymphocytes were also analyzed in cytochalasin B blocked binucleated lymphocytes. The percentage of metaphases with chromosomal aberrations was significantly higher (P less than 0.001) in the exposed group (6.1 +/- 2.3) compared to the control group (2.8 +/- 0.7). The chromosomal aberrations detected were in the form of gaps, breaks and fragments. A significant increase in the incidence of micronucleated lymphocytes was found among the exposed group (7.1 +/- 4.2) compared to the control group (5.4 +/- 2.2) (P less than 0.01). The detected chromosomal damage correlated neither with the duration of exposure nor with the urinary mercury level.

Human cutaneous leishmaniasis in two communities in eastern Sinai, Egypt

Cutaneous leishmaniasis (CL) (L. major) has been documented in soldiers of the Multinational Force in the Sinai as well as in visitors to the area. However, little is known about the prevalence of this disease in the local populations. We identified 2 villages in northeastern Sinai near the infected camps of the Multinational Force and, in a population-based study, measured the prevalence of CL. Populations studied included residents in 2 towns as well as a Bedouin family living on the village periphery. Leishmanial parasites were identified from smears taken from cutaneous lesions. Three of 90 residents in 1 village and 3 of 8 Bedouins had CL. None of 43 residents examined in the second town had CL. Two of 6 individuals had multiple lesions, and at least 1 had recurring ulcers. Five of the 6 affected individuals were males and the 6 represented all age groups. The 6 infected individuals came from 3 families. Infected individuals had traveled outside of the village more frequently than uninfected individuals, suggesting that transmission was more common outside of residential areas.