The Health of the Family in a Changing Arabia

By Zohair Sebai

This study of health services in Turaba villages, Saudi Arabia, was carried out in two stages. The first stage was carried in 1967, whereas the second stage was carried over the following twelve years.

The problem of primary health care in Saudi Arabia, as could be the case in many other parts of the world, is related to the type of medical education and training received by physicians and other health personnel. In order to improve the primary health care system, the starting point would be to improve the objectives and methods of medical education, emphasizing a community-based problem-solving approach.

• Language: English
• Publisher: Partridge Publishing Singapore
• Release date: Oct 24, 2014
• ISBN: 9781482828191

Zohair Sebai

Zohair Sebai, MBBCh, DTM, MPH, DrPH, MRCPG, is a professor of Family and Community Medicine. Since the time he graduated from Bernard-Nocht Institute in Germany with a postgraduate Diploma in Tropical Medicine and from Johns Hopkins School of Public Health in USA with a Master and Dr. in Public Health, Dr. Sebai was occupied by Health Promotion in the Arab World. He was the founder of two medical Schools in Saudi Arabia, the president of the Arab Board for Family and Community Medicine and the president of the Arab Society of School Health and Environment. Dr. Sebai is nationally known as a leader in the field of health education. For 15 years he presented a weekly program on health education in the Saudi Television titled “Medicine and Life”. In the year 2000 he was selected as a Member at Johns Hopkins University Society of Scholars, MJHUSS. Dr. Sebai has served as member in Shoura Council (consultant council to the King) for 12 years and a member of the Board of Trustees of the Arab Gulf University and WHO & UNICEF Short Term Consultant

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Copyright © 2014 by Zohair Sebai.

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CONTENTS

PREFACE

INTRODUCTION

ACKNOWLEDGEMENTS

CHAPTER I

THE LAND AND THE PEOPLE

Saudi Arabia

Turaba

CHAPTER II

TURABA THE PAST 1967

Methodology

Socio-Economic

Maternal and Child Health

Nutrition

Sanitary Environment

Health Status

Health Knowledge and Attitudes

Health Practice

CHAPTER III

TURABA THE PRESENT 1981

A Profile of Changing Turaba

The Health Center

CHAPTER IV

TURABA THE FUTURE 1990

A Plan Of Action

APPENDIX

BIBLIOGRAPHY

LIST OF TABLES

Table - 1 Distribution of hospitals, beds and ambulatory care units according to sector (1979).

Table - 2 Percentage of Saudi Personnel (1980)

Table - 3 Areas of the study, their distances from Souq and number of households studied.

Table - 4 Percent distribution of heads of households by occupation

Table - 5 Percent distribution of households by monthly income in Saudi Riyals

Table - 6 Percent distribution of households possessing certain items of tangible wealth.

Table - 7 Reasons for settlement of people in communities A and B with history of nomadism.

Table - 8 Percent distribution of perceived advantages of settlement over nomadism.

Table - 9 Percent distribution of literacy amongst heads of households and their wives.

Table - 10 Percent distribution of households according to number of members per household.

Table - 11 Percent distribution of households according to relation of members to head.

Table - 12 Percent distribution of heads of households according to number of their present wives.

Table - 13 Average number of pregnancies per mother

Table - 14 Response of mothers to the question of how many more children they want to have.

Table - 15 Percent distribution of mothers responding to the question Can a woman prevent pregnancy?

Table - 16 Percent distribution of pregnant women interviewed

Table - 17 Percent of households who mentioned eating specific types of food yesterday.

Table - 18 Type of milk feeding of children under the study by age group.

Table - 19 Percent distribution of age of introducing solid foods to babies

Table - 20 Distribution of households provided with latrines.

Table - 21 Percent distribution of the most commonly mentioned pests and insects.

Table - 22 Percent distribution of children 0––5 years with four selected complaints.

Table - 23 Percent distribution of children 0––5 years with 2 week history of four selected complaints.

Table - 24 Percent distribution of children who had accidents during the preceeding year.

Table - 25 Live births, infant deaths and infant mortality rate in the preceding year.

Table - 26 Percent distribution of heads of households with history of morbidity in the preceding two weeks.

Table - 27 Percent distribution of mothers with history of morbidity in the preceding two weeks.

Table - 28 Percent distribution of positive clinical findings among children 0––5 years.

Table - 29 Predicted Height and Weight for Males and Females in the Three Communities by Age Group (in months)

Table - 30 Percent distribution of children 0––5 years by level of haemoglobin in gms.

Table - 31 Average values of Hg. in gms. among children by age group

Table - 32 Prevalence of seropositive reaction of FTA test for treponema by age group (Communities B & C combined)

Table - 33 Percent distribution of children 0––5 years with intestinal parasites (Communities B & C combined)

Table - 34 Distribution of beliefs in causes of mental sickness.

Table - 35 Distribution of perceived causes of tuberculosis.

Table - 36 Distribution of perceived causes of fever, body aches & diarrhea (Communities combined).

Table - 37 Percent distribution of people mentioned illness as fatal to children

Table - 38 Percent distribution of respondent’s health demands

Table - 39 Percent distribution of perceived degree of benefits of the health center to the households.

Table - 40 Distribution of reasons for getting little or no service from the health center

Table - 41 Distribution of heads of households stating that selected diseases are treated better by the doctor

Table - 42 The Staff of the Health Center in Souq, Turaba

Table - 43 Distribution of 1,787 out-patients who attended the Health Center over one week by age and sex.

Table - 44 Distribution of diagnosis of 1,787 cases recorded collectively by 3 physicians over one week.

Table - 45 Distribution of drugs prescribed for 1,787 out-patients in one week

Table - 46 Distribution of 94 dental cases seen over one week.

LIST OF FIGURES

Figure 1. Map of Wadi Turaba – the area of the study.

Figure 2. The Branches of Bugum Tribe.

Figure 3. Areas Surveyed In The Pilot Study

Figure 4. Predicted weight and height of male children 0-5 years in Turaba (communities A,C) compared to Harvard standard (50th percentile).

Figure 5. Predicted weight and height of female children 0-5 years in Turaba (communities A,C) compared to Harvard standard (50th percentile).

Figure 6. Percent of reactors to Tine test (2mm +) by age group (Communities B and C combined).

In the name of God, Most Gracious, Most Merciful

PREFACE

T his study of health indicies and services in Turaba, Saudi Arabia was carried out in two stages. The author conducted the field research for his Doctorate degree in Public Health in Turaba in 1967 and this forms the basis of the second chapter of this book. For twelve years following 1969 he worked in the health field, as a planner, administrator and educator. During this period the author perceived that the primary health care system in Saudi Arabia (as well as in many other developing countries he visited) does not fulfill its potential role in promoting the health of the people.

During 1976 and 1981 the author returned to Turaba for two short visits to observe development in the health service system. He noted little change and his observations form the core material for the last two chapters.

In the author’s opinion, the problem of primary care in Saudi Arabia, as could be the case in many other parts of the world, is related to the type of medical education and training received by physicians and other health personnel. In order to improve the primary Health Care System the starting point would be to modify the primary focus of medical education, emphasizing a community based, problem solving approach.

INTRODUCTION

S audi Arabia is a rapidly developing country with promising economic and human resources. From 1960 until 1980 (1380 –– 1400 A.H.) the health resources increased dramatically, well in excess of the population growth rate, particularly since 1974 (1394 A.H.).

Medical education in Saudi Arabia gives another perspective to the changes expected in the future. The graduates from the existing medical schools together with the medical students expected to qualify abroad, will increase the number of Saudi physicians from 460 in 1980 to an estimated 4,450 in 1995. By the year 2014 there became more than 15 medical schools and the number of the Saudi physicians exceeds 15,000.

The expansion of health services is taking place at all levels: primary, secondary and tertiary care. Primary health care has recently gained a great support with more centers to be established during the next ten years.

This study highlights the changes which have occurred in Turaba during the period 1967 - 1981. It presents us a lesson worth learning when planning for the future. The socio-economic development in this rural community has touched family life in many ways, seemingly carrying with it an improvement in health through better housing, nutrition and education.

Although the health center in Turaba was enlarged and its personnel increased during this period its function did not change, that of providing curative and palliative health services to the people. This is not a unique situation. Studies in several rural communities in the country in Asir⁷⁸, Hejaz⁵² and Qasim⁶ ⁷⁹ as well as in other neighboring Arab countries⁷⁶,⁷⁷ showed the same pattern of health services. The problem looks more crucial if we consider that these types of Health Centers provide primary health care for more than 70% of the population.

The example of Turaba indicates that the expansion of health services by increasing the number of health units and personnel does not necessarily bring an improvement in health. The reasons are many: the knowledge and attitudes of the health personnel, determined largely by their hospital-based, curative-oriented medical education, the high percentage of non-Saudis (90% of the physicians and 80% of the paramedics) and the lack of orientation of the health workers to the ecology and health problems of the country.

The expansion of health services should be accompanied by a better understanding of the life style and set of values of the people, better knowledge of the health ecology, and better utilization of health resources, especially human.

This book offers a general framework of the development of primary health care in a rural community in Saudi Arabia, as well as in other Arab countries, based on the study of Turaba.

ACKNOWLEDGEMENTS

I would like to thank H.E. Sheikh Hasan Al El-Sheikh, and H.E. Sheikh Abdul Rahman Aba Al Khayl, whose assistance and support made this study possible.

I am indebted to the people of Turaba in general, and Sheikh Abdulla Al-Assaf, Sheikh Abdulla Bin Muhie and Sheikh Menahi Al Gharmool and the heads of the tribe in particular for their generosity which made our days in Turaba unforgettable.

I extend special thanks and appreciation to all my staff, interviewers, laboratory assistants and school teachers for their sincere help in the field.

I am also grateful to Dr. Timothy D. Baker, Professor of International health, for his continued advice during the early study.

Finally, I am indebted to my wife Ilham, whose loving encouragement, understanding and actual participation, were essential for bringing this study to its final form.

CHAPTER I

THE LAND AND THE PEOPLE

SAUDI ARABIA

Geography and People

O n 18th September 1932, a royal decree was issued by King Abdul-Aziz Bin Saud, proclaiming the dual Kingdoms of Hejaz and Nejd to be unified under the new name, the Kingdom of Saudi Arabia. From the date of its establishment, Saudi Arabia has enjoyed full international recognition