Distribution and determinants of tuberculosis in the Kingdom of Saudi Arabia from 2005 to 2012

Tuberculosis (TB) remains a public health threat in the Kingdom of Saudi Arabia (KSA) with many challenges that limit its prevention and control. To understand how to meet these challenges, this study calculated the TB incidence rates (IRs) in KSA from 2005 to 2012, which were stratified by nationality, sex, and administrative regions. Furthermore, laboratory capabilities were assessed by determining the proportion of laboratory-confirmed TB cases. The overall TB IRs decreased from 15.80/100,000 population in 2005 [95% confidence interval (CI) = 15.29–16.31] to 13.16/100,000 population in 2012 (95% CI = 12.74– 13.58). The IRs were greater for males than for females from 2009 to 2012. The IRs of non-Saudis were approximately two times those of Saudis during the study period. Mecca had greater IR during the study period compared with other regions [25.13/100,000 (95% CI = 24.7–25.56)]. Among non-Saudis, those from Indonesia and Yemen had the greatest proportion of TB cases (15.4% and 12.9%, respectively). Individuals <15 years of age comprised 14.2% of the TB cases. Employed non-Saudis had the greatest proportion of TB (32%), followed by unemployed Saudis (22.38%). The proportion of laboratory-confirmed cases of reported TB was 57% from 2005 to 2012. For effective prevention and control, TB screening should be implemented for non-Saudi workers at ports of entry and laboratory-screening capacity for TB should be evaluated

System Dynamics Model For Hospital Waste Characterisation and Generation in Developing Countries.

Waste management policy makers always face the problem of how to predict the future amount and composition of medical solid waste, which in turn will help determine the most appropriate treatment, recycling and disposal strategy. An accurate prediction can assist in both the planning and design of medical solid waste management systems. Insufficient budget and unavailable management capacity are the main reasons for the scarcity of medical solid waste quantities and components historical records, which are so important in long-term system planning and short-term expansion programs. This paper presents a new technique, using system dynamics modelling, to predict generated medical solid waste in a developing urban area, based on a set of limited samples from Jenin District hospitals, Palestine. The findings of the model present the trend of medical solid waste generation together with its different components and indicate that a new forecasting approach may cover a variety of possible causative models and track inevitable uncertainties when traditional statistical least-squared regression methods are unable to handle such issues

Ethnographic study of the use of interventions during the second stage of labor in Jeddah, Saudi Arabia

BACKGROUND: Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence-based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision-making and practices. METHODS: This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi-structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically. RESULTS: Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision-making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision-making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described. CONCLUSIONS: Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence

Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa

BACKGROUND: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. OBJECTIVES: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. STUDY DESIGN: A generic qualitative approach and an explorative design were utilised in this study. METHODS: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. RESULTS: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. CONCLUSION: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users

The impact of regulatory compliance behavior on hazardous waste generation in European private healthcare facilities

Along with the increased provision of healthcare by private outpatient healthcare facilities within the EU countries, there is also an increase on waste generation from these facilities. A significant fraction of this waste is amongst the most hazardous of all wastes arising in communities, posing significant risks to people and the environment if inappropriately managed. The growing awareness that mismanagement of healthcare waste has serious environmental and public health consequences is reflected in the European waste legislation, aiming at waste prevention at the source and emphasizing the “management” aspects of the waste management process. Whether the increasingly large numbers of private healthcare facilities comply with the existing European waste legislation, and whether compliance with such legislation affects the fraction of healthcare waste classified as hazardous is an understudied subject. Using a large survey of private outpatient healthcare facilities, this study finds that although compliance with the law is far from ideal, it is the strongest factor influencing hazardous waste generation. These findings suggest that more public investments in monitoring healthcare facilities’ compliance with the law in EU countries is warranted, along with increased efforts to raise the facilities’ awareness of the cost savings brought about by compliance with the existing healthcare waste legislation