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Physicians in Saudi Arabia and their Practice Towards Health Surveillance

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I have study called The Knowledge, Attitude and Practice of Ministry of health physicians toward surveillance system in Saudi Arabia. I well send the proposal of the study. I need the Introduction chapter for this study (Example of the references style well be sent at the end of the proposal also you can use these references)

(The Knowledge, Attitude and Practice of Ministry of health physicians toward surveillance system in Saudi Arabia.)


Surveillance is the ongoing systematic collection, analysis and interpretation of healthdata in the process of describing and monitoring a health event. This information is used for planning, implementing and evaluating public health intervention programs.
An epidemiological surveillance system is a set of interrelated elements and activities which contributes to the achievement of surveillance objectives. It is usually well-known as a central part of a health care system in order to monitor priority health events which are known to be taking place in the population.
Once an infectious disease has been detected or suspected it should be notified to the local authorities by whom an operational control measures will be operated. Through reporting, the public health officials are allowed to describe new diseases and the mode of transmission, so the preventive measures can be developed and implemented. As well, it is essential in the planning and evaluation of disease prevention and control.
The first step in the control of a communicable disease is identification; this involves the use of the reporting system.
Epidemiological surveillance is disease for action. For disease control and preventive action to be timely and effective:
1-Epidemiological surveillance should be an essential component of any control program.
2- The surveillance activities should be carried out at all levels of the health service (local, regional, central).
Over the past few years, fears from disease outbreaks have increased in both numbers and complexity. New diseases such as Severe Acute Respiratory Syndrome (SARS) have emerged and other diseases such as Tuberculosis (T.B) have reemerged.
The remarkable increase in international travel and trade in recent years has provided chances for diseases to spread across geopolitical and international boundaries.
GIS has emerged as powerful evidence based practice technology for early detection and timely, but considered, response to disease outbreak. It is an information technology that can educate health professionals and public of the threat of emerging infectious diseases and the agent that cause them. It can enhance decision making at all levels-local, regional, and national. Also the analytical capability of GIS helps in planning disease surveillance activities that reduce the cost and improve efficiency.
The evaluation of surveillance system should endorse the best use of public healthresources by ensuring that only important health events are under surveillance and that surveillance systems operate efficiently.
In Saudi Arabia as in most countries notifiable disease surveillance system relies on mandatory reporting of cases by physicians.
All hospitals and health centers in K.S.A (Kingdom of Saudi Arabia). routinely send their reports to the Communicable Disease Control Department (CDC) in the Primary HealthCare (PHC) directorate of each region. Some diseases must be notified to the department as soon as they are suspected; this is for class 1 diseases that need immediate action they are immediately reported within 24 hours by fax or telephone. Other diseases are reported weekly and this is for class 2 diseases, or monthly which takes place from the regions to the preventive directorate in the MOH. Figure (2) the weekly reports are based on international weeks recommended by (WHO) for all the year.
Although the reporting physicians are the first and most qualified entry post into such an information system, little research is available on the knowledge, attitude, and practices of these physicians regarding surveillance of reportable diseases.
MOH is looking for improving the surveillance system and applying the GIS to it.
1- To assess the knowledge, attitude, and practices of MOH physicians toward the surveillance system.
2- To identify the needs of physicians in order to improve the public health surveillance.
Materials and methods:
Study design: It is a cross sectional, descriptive study that will be conducted at a national level involving all the 20 health regions of K.S.A.
Study population:
The study population is defined as all the MOH physicians working in PHC and in the hospitals (OPD, ER) all over the kingdom.
Data collection:
Regional coordinators were selected from the 20 health regions for distributing and collecting the self administered questionnaire.
Data analysis:
Data entry and analysis will be done using spss software, starting with measuring the frequencies of all the studied variables. The effect of different explanatory variables on different outcomes will be estimated by using appropriate tests of significance.

Example of references style:
1) Waife S, Davenhall B. ESRI Health and Human Services Solutions: Extending Disease Surveillance with GIS. ArcUser [serial on the Internet]. April – June 2005 [cited 2006 Jul 26];[about 2 p.]. Available at:
http://www.esri.com/news/arcuser/0405/disease_surveil1of2.html. Accessed on June 25, 2006.
2) Bakarman MA, Al-Raddadi RM. Assessment of reporting and recording system of communicable diseases in Jeddah Region. Saudi Medical Journal 2000; Vol.21(8):751-754
3) World Health Organization Regional Office for the Eastern Mediterranean. Surveillance of communicable diseases a training manual. Alexandria: 1998 WHO-EM/CDS/52/E/L/06.98/2000.
4) Krause G, Ropers G, Strak K. Notifiable Disease Surveillance and Practicing Physicians. Emerging Infectious Diseases. 2005 March;11(3):442-5.
5) Wuhib T, Chorba TL, Davidiants V, Kenzie WR, McNabb S. Assessment of the infectious diseases surveillance system of the Republic of Armenia: an example of surveillance in the Republics of the former Soviet Union. BMC Public Health; vol.2;2002.
6) Center for Disease Control and Prevention U.S Department of Health and Human services. Principles of Epidemiology.Atlanta Georgia 30333.
7) Guidelines for evaluating surveillance systems. MMWR 1988, 37(S-5);1-18.
8) Ministry of Health. Surveillance in Saudi Arabia. Saudi Epidemiology Bulletin. 1993;1(2)
9) Ministry of Health. Surveillance: Information for action. Saudi Epidemiology Bulletin. 1993;1(1)
10) Seneviratne SL, Gunatilake SB, de Silva HJ. Reporting notifiable diseases: methods for improvement, attitudes and community outcome. Trans R Soc Trop Med Hyg. 1997 Mar-Apr;91(2):135-7.
11) Doyle T, Samuel KG. Completeness of notifiable infectious disease reporting in the United States: An analytical literature review. American Journal of Epidemiology.155(9):866-74.
12) Jajosky RA, Groseclose S. Evaluation of reporting timeliness of public healthsurveillance systems for infectious diseases. BMC Public Health 2004 July, 4:29
13) Ofili AN, Ugwu EN, Ziregbe A, Richars R, Salami S. Knowledge of disease notification among doctors in government hospitals in Benin City, Edo State, Nigeria. Public Health2003 May, 117(3):214-7.
14) Assessment of Infectious Disease Surveillance – Uganda,2000. MMWR 2000 Aug, 49(30);687-91.
15) Nsubuga P, Eseko N, Wuhib T, Ndayimirije N, Chungong S, McNabb S. Structure and performance of infectious disease surveillance and response, United Republic of Tanzania, 1998. Bull World Health Org 2002;80(3):196-202.

References style:
Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Sample References

1. Standard journal article
List the first six authors followed by et al. (Note: NLM now lists all authors.)
Halpern SD, Ubel PA, Caplan AL. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002 Jul 25;347(4):284-7.
As an option, if a journal carries continuous pagination throughout a volume (as many medical journals do) the month and issue number may be omitted.
Halpern SD, Ubel PA, Caplan AL. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
More than six authors:
Rose ME, Huerbin MB, Melick J, Marion DW, Palmer AM, Schiding JK, et al. Regulation of interstitial excitatory amino acid concentrations after cortical contusion injury. Brain Res. 2002;935(1-2):40-6.
2. Organization as author
Diabetes Prevention Program Research Group. Hypertension, insulin, and proinsulin in participants with impaired glucose tolerance. Hypertension. 2002;40(5):679-86.
3. Both personal authors and an organization as author (This example does not conform to NISO standards.)
Vallancien G, Emberton M, Harving N, van Moorselaar RJ; Alf-One Study Group. Sexual dysfunction in 1,274 European men suffering from lower urinary tract symptoms. J Urol. 2003;169(6):2257-61.
4. No author given
21st century heart solution may have a sting in the tail. BMJ. 2002;325(7357):184.

5. Article not in English
(Note: NLM translates the title into English, encloses the translation in square brackets, and adds an abbreviated language designator.)
Ellingsen AE, Wilhelmsen I. Sykdomsangst blant medisin- og jusstudenter. Tidsskr Nor Laegeforen. 2002;122(8):785-7.
6. Volume with supplement
Geraud G, Spierings EL, Keywood C. Tolerability and safety of frovatriptan with short- and long-term use for treatment of migraine and in comparison with sumatriptan. Headache. 2002;42 Suppl 2:S93-9.
7. Issue with supplement
Glauser TA. Integrating clinical trial data into clinical practice. Neurology. 2002;58(12 Suppl 7):S6-12.
8. Volume with part
Abend SM, Kulish N. The psychoanalytic method from an epistemological viewpoint. Int J Psychoanal. 2002;83(Pt 2):491-5.
9. Issue with part
Ahrar K, Madoff DC, Gupta S, Wallace MJ, Price RE, Wright KC. Development of a large animal model for lung tumors. J Vasc Interv Radiol. 2002;13(9 Pt 1):923-8.
10. Issue with no volume
Banit DM, Kaufer H, Hartford JM. Intraoperative frozen section analysis in revision total joint arthroplasty. Clin Orthop. 2002;(401):230-8.
11. No volume or issue
Outreach: bringing HIV-positive individuals into care. HRSA Careaction. 2002 Jun:1-6.
12. Pagination in roman numerals
Chadwick R, Schuklenk U. The politics of ethical consensus finding. Bioethics. 2002;16(2):iii-v.

13. Type of article indicated as needed
Tor M, Turker H. International approaches to the prescription of long-term oxygen therapy [letter]. Eur Respir J. 2002;20(1):242.
Lofwall MR, Strain EC, Brooner RK, Kindbom KA, Bigelow GE. Characteristics of older methadone maintenance (MM) patients [abstract]. Drug Alcohol Depend. 2002;66 Suppl 1:S105.
14. Article containing retraction
Feifel D, Moutier CY, Perry W. Safety and tolerability of a rapidly escalating dose-loading regimen for risperidone. J Clin Psychiatry. 2002;63(2):169. Retraction of: Feifel D, Moutier CY, Perry W. J Clin Psychiatry. 2000;61(12):909-11.
15. Article retracted
Feifel D, Moutier CY, Perry W. Safety and tolerability of a rapidly escalating dose-loading regimen for risperidone. J Clin Psychiatry. 2000;61(12):909-11. Retraction in: Feifel D, Moutier CY, Perry W. J Clin Psychiatry. 2002;63(2):169.
16. Article republished with corrections
Mansharamani M, Chilton BS. The reproductive importance of P-type ATPases. Mol Cell Endocrinol. 2002;188(1-2):22-5. Corrected and republished from: Mol Cell Endocrinol. 2001;183(1-2):123-6.
17. Article with published erratum
Malinowski JM, Bolesta S. Rosiglitazone in the treatment of type 2 diabetes mellitus: a critical review. Clin Ther. 2000;22(10):1151-68; discussion 1149-50. Erratum in: Clin Ther 2001;23(2):309.
18. Article published electronically ahead of the print version
Yu WM, Hawley TS, Hawley RG, Qu CK. Immortalization of yolk sac-derived precursor cells. Blood. 2002 Nov 15;100(10):3828-31. Epub 2002 Jul 5.
Books and Other Monographs
19. Personal author(s)
Murray PR, Rosenthal KS, Kobayashi GS, Pfaller MA. Medical microbiology. 4th ed. St. Louis: Mosby; 2002.
20. Editor(s), compiler(s) as author
Gilstrap LC 3rd, Cunningham FG, VanDorsten JP, editors. Operative obstetrics. 2nd ed. New York: McGraw-Hill; 2002.
21. Author(s) and editor(s)
Breedlove GK, Schorfheide AM. Adolescent pregnancy. 2nd ed. Wieczorek RR, editor. White Plains (NY): March of Dimes Education Services; 2001.
22. Organization(s) as author
Royal Adelaide Hospital; University of Adelaide, Department of Clinical Nursing. Compendium of nursing research and practice development, 1999-2000. Adelaide (Australia): Adelaide University; 2001.
23. Chapter in a book
Meltzer PS, Kallioniemi A, Trent JM. Chromosome alterations in human solid tumors. In: Vogelstein B, Kinzler KW, editors. The genetic basis of human cancer. New York: McGraw-Hill; 2002. p. 93-113.
24. Conference proceedings
Harnden P, Joffe JK, Jones WG, editors. Germ cell tumours V. Proceedings of the 5th Germ Cell Tumour Conference; 2001 Sep 13-15; Leeds, UK. New York: Springer; 2002.
25. Conference paper
Christensen S, Oppacher F. An analysis of Koza’s computational effort statistic for genetic programming. In: Foster JA, Lutton E, Miller J, Ryan C, Tettamanzi AG, editors. Genetic programming. EuroGP 2002: Proceedings of the 5th European Conference on Genetic Programming; 2002 Apr 3-5; Kinsdale, Ireland. Berlin: Springer; 2002. p. 182-91.
26. Scientific or technical report
Issued by funding/sponsoring agency:
Yen GG (Oklahoma State University, School of Electrical and Computer Engineering, Stillwater, OK). Health monitoring on vibration signatures. Final report. Arlington (VA): Air Force Office of Scientific Research (US), Air Force Research Laboratory; 2002 Feb. Report No.: AFRLSRBLTR020123. Contract No.: F049.

Issued by performing agency:
Russell ML, Goth-Goldstein R, Apte MG, Fisk WJ. Method for measuring the size distribution of airborne Rhinovirus. Berkeley (CA): Lawrence Berkeley National Laboratory, Environmental Energy Technologies Division; 2002 Jan. Report No.: LBNL49574. Contract No.: DEAC0376SF00098. Sponsored by the Department of Energy.
27. Dissertation
Borkowski MM. Infant sleep and feeding: a telephone survey of Hispanic Americans [dissertation]. Mount Pleasant (MI): Central Michigan University; 2002.
28. Patent
Pagedas AC, inventor; Ancel Surgical R&D Inc., assignee. Flexible endoscopic grasping and cutting device and positioning tool assembly. United States patent US 98. 2002 Aug 1.
Other Published Material
29. Newspaper article
Tynan T. Medical improvements lower homicide rate: study sees drop in assault rate. The Washington Post. 2002 Aug 12;Sect. A:2 (col. 4).
30. Audiovisual material
Chason KW, Sallustio S. Hospital preparedness for bioterrorism [videocassette]. Secaucus (NJ): Network for Continuing Medical Education; 2002.
31. Legal Material
Public law:
Veterans Hearing Loss Compensation Act of 2002, Pub. L. No. 107-9, 115 Stat. 11 (May 24, 2001).
Unenacted bill:
Healthy Children Learn Act, S. 1012, 107th Cong., 1st Sess. (2001).
Code of Federal Regulations:
Cardiopulmonary Bypass Intracardiac Suction Control, 21 C.F.R. Sect. 870.4430 (2002).

Arsenic in Drinking Water: An Update on the Science, Benefits and Cost: Hearing Before the Subcomm. on Environment, Technology and Standards of the House Comm. on Science, 107th Cong., 1st Sess. (Oct. 4, 2001).
32. Map
Pratt B, Flick P, Vynne C, cartographers. Biodiversity hotspots [map]. Washington: Conservation International; 2000.
33. Dictionary and similar references
Dorland’s illustrated medical dictionary. 29th ed. Philadelphia: W.B. Saunders; 2000. Filamin; p. 675.
Unpublished Material
34. In press
(Note: NLM prefers “forthcoming” because not all items will be printed.)
Tian D, Araki H, Stahl E, Bergelson J, Kreitman M. Signature of balancing selection in Arabidopsis. Proc Natl Acad Sci U S A. In press 2002.
Electronic Material
35. CD-ROM
Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.
36. Journal article on the Internet
Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [serial on the Internet]. 2002 Jun [cited 2002 Aug 12];102(6):[about 3 p.]. Available from: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm
37. Monograph on the Internet
Foley KM, Gelband H, editors. Improving palliative care for cancer [monograph on the Internet]. Washington: National Academy Press; 2001 [cited 2002 Jul 9]. Available from: http://www.nap.edu/books/9/html/.

38. Homepage/Web site
Cancer-Pain.org [homepage on the Internet]. New York: Association of Cancer Online Resources, Inc.; c2000-01 [updated 2002 May 16; cited 2002 Jul 9]. Available from: http://www.cancer-pain.org/.
39. Part of a homepage/Web site
American Medical Association [homepage on the Internet]. Chicago: The Association; c1995-2002 [updated 2001 Aug 23; cited 2002 Aug 12]. AMA Office of Group Practice Liaison; [about 2 screens]. Available from: http://www.ama-assn.org/ama/pub/category/1736.html
40. Database on the Internet
Open database:
Who’s Certified [database on the Internet]. Evanston (IL): The American Board of Medical Specialists. c2000 – [cited 2001 Mar 8]. Available from: http://www.abms.org/newsearch.asp
Closed database:
Jablonski S. Online Multiple Congential Anomaly/Mental Retardation (MCA/MR) Syndromes [database on the Internet]. Bethesda (MD): National Library of Medicine (US). c1999 [updated 2001 Nov 20; cited 2002 Aug 12]. Available from: http://www.nlm.nih.gov/mesh/jablonski/syndrome_title.html
41. Part of a database on the Internet
MeSH Browser [database on the Internet]. Bethesda (MD): National Library of Medicine (US); 2002 – [cited 2003 Jun 10]. Meta-analysis; unique ID: D015201; [about 3 p.]. Available from: http://www.nlm.nih.gov/mesh/MBrowser.html Files updated weekly.
MeSH Browser [database on the Internet]. Bethesda (MD): National Library of Medicine (US); 2002 – [cited 2003 Jun 10]. Meta-analysis; unique ID: D015201; [about 3 p.]. Available from: http://www.nlm.nih.gov/mesh/MBrowser.html Files updated weekly.

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