Kingdom of Saudi Arabia Relation to The Hypertension - Research Paper Example

Community Assessment of Hypertension in Saudi Arabia Introduction Hypertension is one of the common problems in the world and a major public health challenge for clinicians and other health practitioners. The condition has gained lot of importance because of the potential to cause devastating health consequences like coronary artery disease, congestive heart failure, stroke, peripheral vascular disease and end-stage renal disease, all of which are leading contributors for mortality and morbidity (Dreisbach, and Sharma, 2010). The transition of Saudi Arabia from a nomadic country to an urbanised and industrialised country has contributed to the rise in hypertension in the country (Mahfouz and Al-Erian, 1993). In this exercise, community assessment and planning of hypertension in Saudi Arabia will be discussed with reference to recommendations for future service delivery based on the outcomes of this assessment. In this report, community refers to people with hypertension living in Saudi Arabia. The community profile described below will provide an overview of the relevant demographic, geographic and health systems information pertaining to this community and area. The health status and health needs of this hypertension community will be identified by means of a community assessment plan. Community Profile Demographic information pertaining to the hypertension community of Saudi Arabia is limited and hence, the profile of population of Saudi Arabia and epidemiological data pertaining to hypertension is provided. The components of St.John and Kehlers (2007; 83- 84) community and needs assessment profile template will be used for this community profile. Geographic Information: Saudi Arabia, which is officially called the Kingdom of Saudi Arabia, is located in the Southwest Asia. The country borders Persian Gulf, Red Sea and North of Yemen and occupies 80 percent of the Arabian Pennisula. The area of the land is about 2,000,000 square kilometers. The kingdom is bordered by Yemen on the south, Jordan and Iraq on the north and northeast, Oman on the southeast and Kuwait, Qatar, Bahrain and the United Arab Emirates on the east (CIA World Factbook, 2010). The kingdom is divided into 13 provinces with each province having a capital (Appendix-1). Demographic information (Refer to Appendix-2): 1. Population characteristics: According to the WHO (2009), the population of Saudi Arabia is over 24,807 thousands of which 5.5 million are foreign residents. More than 95 percent of the population are settled. The population growth rate is 1.848 percent (CIA World Factbook, 2010). 85 percent are urban population (WHO, 2009). 2. Age distribution: 59.4 percent of the population are between 15- 64 years and only 2.4 percent are over 65 years. The rest are between 0-14 years (CIA World Factbook, 2010). 3. Gender distribution: The male: female ratio of general population is 1.21 (CIA World Factbook, 2010). 4. Ethnicity: Most of the Saudis are basically Arabs. Other ethnic groups include Iranians, Indians, Africans, Turks and Indonesians (CIA World Factbook, 2010). 5. Demography The crude birth rate is 24.1 births per 1000 population, crude death rate is 3.9deaths per 1000 population (WHO, 2009) and infant mortality rate is 11.57 per 1000 live births (CIA World Factbook, 2010). The population growth rate is 2.3 percent (WHO, 2009). Socioeconomic characteristics: 1. Economy The economy of Saudi Arabia is a centrally planned one. The private enterprises are also regulated by the government. The economy is oil-based and the country possess 25 percent of the Worlds petroleum reserves. Infact, the country is the largest exporter of petroleum in the world. 45 percent of the budget revenues and 90 percent of the earnings from export are petroleum based (CIA World Factbook, 2010). 2. Living arrangements People in Saudi Arabia often live in family groups that are extended. Infact, several villas are attached to one another under a single compound. Within one set of villas in a single compound, grand parents, married children, unmarried children and other may live together (Huda, 2008). Some private homes may have high walls with intentions to protect family from the prying eyes of the neighbours. Most of the private homes have separate entrances for women and men. Even the visitor rooms, garage gates and door to family drivers room are separate for men and women. thus there are many gates to one single home (Huda, 2008). Hypertension and Saudi Arabia population. 1. Incidence and prevalence The prevalence of hypertension in Saudi Arabia is 26.1 percent. In males, the prevalence is higher, about 23.9 percent, and in females it is about 22.4 percent. the prevalence in urban population is higher (27.9 percent) as against rural population (22.4 percent). The prevalence of hypertension is different in different populations. The highest prevalence is in the Eastern province and the lowest prevalence rates are in Central and South-Western provinces (Al-Nozha, 2007). Hypertension increases the risk of coronary artery disease. The prevalence of this disease is 8.2 percent in hypertensive patients while it is only 4.5 percent in normotensive patients (Al-Nozha et al, 2007). 2. Age distribution According to a cross-sectional study conducted by Al-Nozha et al (1997), "12.4% and 7.9% of children younger than 18 years were systolic and diastolic hypertensive." Also, in those above 18 years of age, "5.3% were systolic and 7.3% were diastolic hypertensives." Another important finding in this study was "87.5% of systolic and 79.4% of diastolic hypertensives were aged 40 years and over." According to a study by Al-Homrany et al (2008), 61 percent of hypertensive patients are between 45- 64 years of age. 3. Gender In males, the prevalence ranges from 1.4 to 18.7 percent and in females it ranges from 0.9 to 14 percent (El-Hazmi, 1998). According to Al-Nozha et al (1997), "females had statistically significant elevated systolic hypertension compared with males (P < 0.01)." According to a study by Al-Homrany et al (2008), 56 percent of hypertensive patients in primary health centers were females. Health issues Hypertension may be defined as presence of abnormally high blood pressure. According to the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- Report-7 (Riaz, 2007), blood pressure in adults above 18 years of age may be defined as follows: Normal† - Systolic lower than 120, diastolic lower than 80 Prehypertension - Systolic 120-139, diastolic 80-99 Stage 1 - Systolic 140-159, diastolic 90-99 Stage 2 - Systolic equal to or more than 160, diastolic equal to or more than 100 This definition has been adopted by the Saudi Hypertension management Group (Saudi Hypertension Management Guidelines, 2007). According to an article by Al-Mazmomi, published in The Saudi Gazette, health experts in Saudi are worried about he increase in the number of people suffering from hypertension. Elevated blood pressure which has been uncontrolled for a prolonged duration of time can lead to many changes in the structure, blood vessels and the conducting system of the heart. These changes can lead to the development of various conditions of the heart such as coronary artery disease, left ventricular hypertrophy, cardiac arrhythmias and congestive heart failure. The pathophysiology of hypertensive heart disease is a complex interplay of various structural, neuroendocrine, hemodynamic, molecular and cellular factors (Riaz, 2007). These factors not only have a role in the development of hypertensive heart disease, they also are modulated by elevated blood pressure (Riaz, 2007). Persistent elevation of BP has adverse effects on the cardiac function and structure due to increased afterload and also due to vascular and neurohormonal changes (Riaz, 2007). Other than the effects on heart, hypertension also leads to damage to other organs contributing to stroke, end-stage renal disease, peripheral vascular disease and metabolic syndrome (Dreisbach, and Sharma, 2010). The study by Al-Homrany (2010) reported that 92 percent of hypertensive patients have primary hypertension and 25 percent have positive family history. The condition is well controlled in 63 percent of patients. 58 percent people with hypertension are inflicted with obesity and 9 percent have hypertension-related complications. 50 percent of patients are compliant with treatment , while the rest are not compliant (Al-Homrany, 2010). Summary of Key Findings 1. More than a quarter of people in Saudi Arabia suffer from hypertension. The incidence is slightly higher in males. 2. Hypertension is associated with significant devastating complications like myocardial infarction. 3. Demographic and statistical information about the hypertension coummunity is not readily available. 4. All the levels of health services cater to the needs of hypertension community. But there is variability in delivery of treatment, with some primary centers lacking in following standard guidelines. 5. The Government of the Kingdom has taken management of hypertension very seriously and has issued guidelines for effective management Access to Health Services The community members have access to various health care services provided by various levels of health care, the primary, secondary and tertiary. The government gives high priority to the health sector and all citizens of Saudi get free and high standard health care. The Ministry of health is responsible for healthcare in both private and public sectors. The health care coverage is universal. there are 2 tiers of the system. The first tier consists of the primary healthcare centers and clinics which take care of basic services, emergencies, preventive care and prenatal care. The second tier consists of the hospitals and specialized care centers in urban areas. There are about 350 hospitals acquainted with nearly 48,000 beds. 62 percent of the hospitals and 53 percent of medical centers and clinics are operated by the Ministry of Health (Helen Ziegler Associates, 2007). The Ministry of Health Facilities are located both in cities and towns and serve the general public. The military hospitals serve the armed forces personnel and members of their families. The vision of Ministry of Health is "to realize health in its comprehensive concept at all individual, family and community levels, maintaining health in both quantity and quality, and help the elderly and those of special needs by enabling them to accommodate with their health situations in coordination with different health care providers at both private and public sectors" (Ministry of Health, 2010). Community Health Services: There are several community based programs and services in Saudi for adult population which can be accessed by the community (Appendix-3). The services include allied health, nursing, home care and others. Certain quality assurance guidelines have been introduced by the Ministry of Health, Kingdom of Saudi Arabia to improve management of hypertension (Al- Homrany et al, 2008). Such guidelines came into dawn after the understanding of the fact that effective management of hypertension reduces the risk of development of myocardial infarction and other vascular complications like stroke. Barriers to effective primary care of hypertension include poor compliance from patient, missing of important procedures, poor adherence to national competency standards, lack of updating systems, poor laboratory services and lack of recall systems (Al- Homrany et al, 2008). Factors which have promoted primary health care include commitment from political, government, social and financial sectors, efficient management, decentralization, trained, committed and well-oriented health personnel and involvement of community in local decisions (Al-Khuzayem, et al, 1997). In a study conducted by Al-Ahmadi and Roland, there is variation in the quality of services provided by different primary care units. The study found that management of chronic diseases like hypertension was not effective and was lacking in prescribing patterns, health education, interpersonal care and appropriate referral patterns. In 2001, The Saudi Hypertension Management Society was formed that developed guidelines for management of hypertension in Saudi Arabia. The guidelines were developed in collaboration with several health professional groups, in accordance with national intentional standards and norms. The work is also translated into the local language (The Saudi Hypertension Management Society, 2007). Community Assessment To assess the hypertension community in Saudi Arabia, a steering committee needs to be established involving key stakeholders who can understand the needs and concerns of this community. The role of such a committee is to identify the process of designing the assessment, strategies to implement, coordinate the processes, identify resources and find resources for funds. Based on the ideas of the members of the steering committee, surveys must be developed with reference to various key issues identified in the community profile and after gaining inputs from various stakeholders. The final draft of the surveys must be tested on a sample population to ensure the adequacy and accuracy of data in the surveys. Information pertaining to utilization of the services by the community is lacking and hence it is may be necessary to conduct survey of community health centers catering to the needs of adult population, with intentions to ascertain and evaluate the utilization of health services, various health issues and problems of the community, overlaps and loopholes in the service delivery. After the primary survey, a survey of a sample of people with hypertension will be conducted. For the survey, advertisements will be presented through various channels, inviting adults with hypertension to participate. the purpose of this survey is to identify demographic information about hypertension community in Saudi Arabia, to ascertain the clinical presentations, comorbidities and complications of the disease, to evaluate the treatment provided and whether the treatments given are in accordance with standard guidelines for the management of hypertension at international standards, accessibility to health services and to ascertain any health issues not addressed currently. The understanding of the needs and problems of the community through survey will be upheld by involving representatives from stakeholder groups, trained moderator and a focus group. Through coordination of these members, a report will be formed which will be presented to the steering committee, service providers and members of the community. Involvement of family and carers is very essential in community assessment for holistic management approach. Also, the cultural, linguistic and ethnic aspects of various individuals of the community must also be taken care of. Critical Analysis and Recommendations Hypertension is a chronic and incurable condition that contributes significantly to morbidity and mortality. Several health-related issues have been identified through the community assessment and recommendations are provided based on the findings. Health Issues: Several issues were identified in the process of conducting this community profile and assessment plan 1. The prevalence of the condition is very high and infact more than a quarter of people from Saudi suffer due to this disease. 2. The disease is associated with increased risk for development of devastating consequences like coronary artery disease. 3. Though the condition mainly affects those above 45 years of age, even adolescents and children can develop the condition. 4. Presence of comorbid conditions like diabetes mellitus worsens the chances of developing end-organ diseases. 5. The delivery of care is present at all levels of health care system, but many health providers do not adhere to standard treatment regimens and the compliance for the treatment is only 50 percent. Community strengths: 1. The Government of Saudi has taken lot of interest in the prevention and management of hypertension in Saudi Arabia and has issued guidelines for the management of the condition based on expert opinion and international standards of treatment. Infact, the treatment is available even in local language and incorporate management in special situations like Ramzan. 2. There is also growing education of the people of the community about the need to manage the condition efficiently. Challenges for the community: 1. The services for the community are good. However, there is variability in terms of care like adherence to standard regimens of treatment, appropriate investigations, laboratory access and follow up. 2. The management is lacking in prescribing patterns, health education, interpersonal care and appropriate referral patterns. Recommendations: 1. To increase awareness amongst health professionals about the need to follow standards of treatment. 2. To educate the public and the patients about the consequences of hypertension and the need to control it effectively 3. Specialist approach of management for those with comorbid conditions. 4. Routine screening for those above 40 years at work place or at primary health centers when they come for general check up. References Akbar, D.H. (2001). Is hypertension common in hospitalized type 2 diabetic patients?Saudi Medical Journal, 22 (2), 139-141. Al-Ahmadi, H., and Roland, M. (2005). Quality of primary health care in Saudi Arabia: a comprehensive review. International Journal for Quality in Health Care, 17(4), 331- 346. Al-Homrany, M.A., Khan, M.Y., Al-Khadi, Y.M., et al. (2008). Hypertension care at primary health care centers: A report from Abha, Saudi Arabia. Saudi J Kidney Dis Transpl, 19, 990-6. Al-Khuzayem, A.A.M., Mahfouz, A.A., Shehata, A.I., and Al-Erian, R.A.G. (1997). Health services delivery in Asir, Saudi Arabia: regional experience of integration. Eastern Mediterranean Health Journal, 3(2), 228- 235. Al-Mazmomi, N. (2010). Hypertension: The silent but deadly disease. Saudi-Gazzette. Retrieved on 22nd May, 2010 from http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentID=2010050871655 Al-Nozha, M., M., Abdullah, M., Arafah, M. R., et al. (2007). Hypertension in Saudi Arabia. Saudi Medical Journal, 28(1), 77- 84. Al-Nozha, M.M., Ali, M.S., Osman, A.K. (1997). Arterial hypertension in Saudi Arabia. Ann Saudi Med., 17(2), 170-4. CIA World Factbook. (2010). Saudi Arabia. Retrieved on 22nd May, 2010 from https://www.cia.gov/library/publications/the-world-factbook/geos/sa.html Dreisbach, A.W., and Sharma, S. (2010). Hypertension. Emedicine from WebMD. Retrieved on 22nd May, 2010 from http://emedicine.medscape.com/article/241381-overview El-Hazmi, M.A.F., Warsy, A.S., Al-Swailem, A.R., et al. (1998). Prevalence of hypertension in adult Saudi population. Saudi Medical Journal, 19(2), 117- 122. Farlex Free Library. (2001). Saudi Arabia: The Geology. Retrieved on 22nd May, 2010 from http://www.thefreelibrary.com/SAUDI+ARABIA+-+The+Geology.-a079121626 Helen Ziegler Associates. (2007). The Healthcare System of Saudi Arabia. http://www.hziegler.com/locations/middle-east/saudi-arabia/articles/healthcare-system-of-saudi-arabia.html Huda. (2008). Shared Villas for Extended Family. Retrieved on 26th May, 2010 from http://islam.about.com/od/saudiarabia/ig/Riyadh/villashared.htm Mahfouz, A.A.R., and Al-Erian, R.A.G. (1993). Hypertension in Asir Region, SouthWestern Saudi Arabia: an epdemiologic study. South Asean J Trop Med Public Health, 24(2), 284- 286. Ministry of Health. (2010). Vision and Mission. http://www.moh.gov.sa/en/modules/mysections/article.php?lid=14 Riaz, K. (2007). Hypertensive Heart Disease. Emedicine from WebMD. Retrieved on 26th May, 2010 from http://emedicine.medscape.com/article/162449-overview St John, W. and Keleher, H. (2007). Community health assessment in health. In W. St John & H. Keleher (Eds.). Community nursing practice: theory, skills and issues (pp. 77-90). Crows Nest, NSW: Allen & Unwin Saudi Hypertension Management Group. (2007). Saudi Hypertension Management Guidelines. Saudi Hypertension Management Guidelines. Retrieved on 26th May, 2010 from http://www.saudi-hypertension.org/guidelines.pdf WHO. (2009). Country profiles: Saudi Arabia. Retrieved on 26th May, 2010 from http://www.emro.who.int/emrinfo/index.asp?Ctry=saa Appendix-1: Map of Saudi Arabia with borders (CIA World Facts) Appendix-2: Population, Demography, Government and Socio-economy of Saudi-Arabia (CIA World Facts). Population: 29,207,277 country comparison to the world: 41 note: includes 5,576,076 non-nationals (July 2010 est.) Age structure: 0-14 years: 38% (male 5,657,533/female 5,435,799) 15-64 years: 59.5% (male 9,731,831/female 7,655,385) 65 years and over: 2.5% (male 369,538/female 357,191) (2010 est.) Median age: total: 21.6 years male: 22.9 years female: 20 years (2010 est.) Population growth rate: 1.75% (2010 est.) country comparison to the world: 71 Birth rate: 28.21 births/1,000 population (2010 est.) country comparison to the world: 48 Death rate: 2.45 deaths/1,000 population (July 2010 est.) country comparison to the world: 219 Net migration rate: -8.26 migrant(s)/1,000 population (2010 est.) country comparison to the world: 170 Urbanization: urban population: 82% of total population (2008) rate of urbanization: 2.5% annual rate of change (2005-10 est.) Sex ratio: at birth: 1.05 male(s)/female under 15 years: 1.04 male(s)/female 15-64 years: 1.27 male(s)/female 65 years and over: 1.03 male(s)/female total population: 1.17 male(s)/female (2010 est.) Infant mortality rate: total: 11.2 deaths/1,000 live births country comparison to the world: 147 male: 12.73 deaths/1,000 live births female: 9.6 deaths/1,000 live births (2010 est.) Life expectancy at birth: total population: 76.51 years country comparison to the world: 69 male: 74.41 years female: 78.71 years (2010 est.) Total fertility rate: 3.77 children born/woman (2010 est.) country comparison to the world: 44 HIV/AIDS - adult prevalence rate: 0.01% (2001 est.) country comparison to the world: 169 HIV/AIDS - people living with HIV/AIDS: NA HIV/AIDS - deaths: NA Nationality: noun: Saudi(s) adjective: Saudi or Saudi Arabian Ethnic groups: Arab 90%, Afro-Asian 10% Religions: Field info displayed for all countries in alpha order. Muslim 100% Languages: Arabic Literacy: definition: age 15 and over can read and write total population: 78.8% male: 84.7% female: 70.8% (2003 est.) Education expenditures: 6.8% of GDP (2004) country comparison to the world: 28 Back to Top Government ::Saudi Arabia Country name: conventional long form: Kingdom of Saudi Arabia conventional short form: Saudi Arabia local long form: Al Mamlakah al Arabiyah as Suudiyah local short form: Al Arabiyah as Suudiyah Government type: monarchy Capital: name: Riyadh geographic coordinates: 24 38 N, 46 43 E time difference: UTC+3 (8 hours ahead of Washington, DC during Standard Time) Administrative divisions: 13 provinces (mintaqat, singular - mintaqah); Al Bahah, Al Hudud ash Shamaliyah (Northern Border), Al Jawf, Al Madinah, Al Qasim, Ar Riyad (Riyadh), Ash Sharqiyah (Eastern), Asir, Hail, Jizan, Makkah, Najran, Tabuk Independence: 23 September 1932 (unification of the kingdom) National holiday: Unification of the Kingdom, 23 September (1932) Constitution: governed according to Islamic law; the Basic Law that articulates the governments rights and responsibilities was promulgated by royal decree in 1992 Legal system: based on sharia law, several secular codes have been introduced; commercial disputes handled by special committees; has not accepted compulsory ICJ jurisdiction Suffrage: 21 years of age; male Executive branch: chief of state: King and Prime Minister ABDALLAH bin Abd al-Aziz Al Saud (since 1 August 2005); Heir Apparent Crown Prince SULTAN bin Abd al- Aziz Al Saud (half brother of the monarch); note - the monarch is both the chief of state and head of government head of government: King and Prime Minister ABDALLAH bin Abd al-Aziz Al Saud (since 1 August 2005); Deputy Prime Minister SULTAN bin Abd al-Aziz Al Saud; Second Deputy Prime Minister NAYIF bin Abd Al-Aziz Al Saud cabinet: Council of Ministers appointed by the monarch every four years and includes many royal family members (For more information visit the World Leaders website Opens in New Window) elections: none; the monarchy is hereditary; note - an Allegiance Commission created by royal decree in October 2006 established a committee of Saudi princes that will play a role in selecting future Saudi kings, but the system will not take effect until after Crown Prince Sultan becomes king Legislative branch: Consultative Council or Majlis al-Shura (150 members and a chairman appointed by the monarch to serve four-year terms); note - though the Council of Ministers announced in October 2003 its intent to introduce elections for half of the members of local and provincial assemblies and a third of the members of the national Consultative Council or Majlis al-Shura incrementally over a period of four to five years, to date no such elections have been held or announced Judicial branch: Supreme Council of Justice Political parties and leaders: none Political pressure groups and leaders: Ansar Al Marah (supports womens rights) other: gas companies; religious groups International organization participation: ABEDA, AfDB (nonregional member), AFESD, AMF, BIS, FAO, G-20, G-77, GCC, IAEA, IBRD, ICAO, ICC, ICRM, IDB, IFAD, IFC, IFRCS, IHO, ILO, IMF, IMO, IMSO, Interpol, IOC, IOM (observer), IPU, ISO, ITSO, ITU, LAS, MIGA, NAM, OAPEC, OAS (observer), OIC, OPCW, OPEC, PCA, UN, UNCTAD, UNESCO, UNIDO, UNRWA, UNWTO, UPU, WCO, WFTU, WHO, WIPO, WMO, WTO Diplomatic representation in the US: chief of mission: Ambassador Adil al-Ahmad al-JUBAYR chancery: 601 New Hampshire Avenue NW, Washington, DC 20037 telephone: [1] (202) 342-3800 FAX: [1] (202) 944-3113 consulate(s) general: Houston, Los Angeles, New York Diplomatic representation from the US: chief of mission: Ambassador James B. SMITH embassy: Collector Road M, Diplomatic Quarter, Riyadh mailing address: American Embassy, Unit 61307, APO AE 09803-1307; International Mail: P. O. Box 94309, Riyadh 11693 telephone: [966] (1) 488-3800 FAX: [966] (1) 488-7360 consulate(s) general: Dhahran, Jiddah (Jeddah) Flag description: green, a traditional color in Islamic flags, with the Shahada or Muslim creed in large white Arabic script (translated as "There is no god but God; Muhammad is the Messenger of God") above a white horizontal saber (the tip points to the hoist side); design dates to the early twentieth century and is closely associated with the Al Saud family which established the kingdom in 1932 Back to Top Economy ::Saudi Arabia Economy - overview: Saudi Arabia has an oil-based economy with strong government controls over major economic activities. It possesses about 20% of the worlds proven petroleum reserves, ranks as the largest exporter of petroleum, and plays a leading role in OPEC. The petroleum sector accounts for roughly 80% of budget revenues, 45% of GDP, and 90% of export earnings. Saudi Arabia is encouraging the growth of the private sector in order to diversify its economy and to employ more Saudi nationals. Diversification efforts are focusing on power generation, telecommunications, natural gas exploration, and petrochemical sectors. Roughly 5.5 million foreign workers play an important role in the Saudi economy, particularly in the oil and service sectors, while Riyadh is struggling to reduce unemployment among its own nationals. Saudi officials are particularly focused on employing its large youth population, which generally lacks the education and technical skills the private sector needs. Riyadh has substantially boosted spending on job training and education, most recently with the opening of the King Abdallah University of Science and Technology - Saudi Arabias first co-educational university. As part of its effort to attract foreign investment, Saudi Arabia acceded to the WTO in December 2005 after many years of negotiations. The government has begun establishing six "economic cities" in different regions of the country to promote economic development. Five years of high oil prices during 2004-08 gave the Kingdom ample financial reserves to manage the impact of the global financial crisis, but tight international credit, falling oil prices, and the global economic slowdown reduced Saudi economic growth in 2009, prompting the postponement of some economic development projects. Saudi authorities supported the banking sector during the crisis by making direct capital injections into banks, reducing rates, and publicly affirming the governments guarantee of bank deposits. GDP (purchasing power parity): $585.8 billion (2009 est.) country comparison to the world: 23 $584.7 billion (2008 est.) $560 billion (2007 est.) note: data are in 2009 US dollars GDP (official exchange rate): Field info displayed for all countries in alpha order. $384 billion (2009 est.) GDP - real growth rate: Field info displayed for all countries in alpha order. 0.2% (2009 est.) country comparison to the world: 109 4.4% (2008 est.) 3.3% (2007 est.) GDP - per capita (PPP): $20,400 (2009 est.) country comparison to the world: 60 $20,800 (2008 est.) $20,300 (2007 est.) note: data are in 2009 US dollars GDP - composition by sector: agriculture: 3.2% industry: 60.4% services: 36.4% (2009 est.) Labor force: 6.922 million country comparison to the world: 62 note: about 80% of the labor force is non-national (2009 est.) Labor force - by occupation: agriculture: 6.7% industry: 21.4% services: 71.9% (2005 est.) Unemployment rate: 11.6% (2009 est.) country comparison to the world: 126 11.8% (2008 est.) note: data are for Saudi males only (local bank estimates; some estimates range as high as 25%) Population below poverty line: NA% Household income or consumption by percentage share: Field info displayed for all countries in alpha order. lowest 10%: NA% highest 10%: NA% Investment (gross fixed): 24.2% of GDP (2009 est.) country comparison to the world: 49 Budget: revenues: $167.7 billion expenditures: $164.3 billion (2009 est.) Public debt: 20.3% of GDP (2009 est.) country comparison to the world: 100 18.9% of GDP (2008 est.) Inflation rate (consumer prices): 5% (2009 est.) country comparison to the world: 141 9.9% (2008 est.) Central bank discount rate: 2.5% (31 December 2008) NA% (31 December 2007) Commercial bank prime lending rate: Field info displayed for all countries in alpha order. NA% Stock of money: Field info displayed for all countries in alpha order. $113.2 billion (31 December 2008) country comparison to the world: 15 $102.4 billion (31 December 2007) Stock of quasi money: $134.3 billion (31 December 2008) country comparison to the world: 19 $109.5 billion (31 December 2007) Stock of domestic credit: $NA (31 December 2008) $66.94 billion (31 December 2007) Market value of publicly traded shares: $246.3 billion (31 December 2008) country comparison to the world: 20 $515.1 billion (31 December 2007) $326.9 billion (31 December 2006) Agriculture - products: wheat, barley, tomatoes, melons, dates, citrus; mutton, chickens, eggs, milk Industries: crude oil production, petroleum refining, basic petrochemicals, ammonia, industrial gases, sodium hydroxide (caustic soda), cement, fertilizer, plastics, metals, commercial ship repair, commercial aircraft repair, construction Industrial production growth rate: -7.2% (2009 est.) country comparison to the world: 125 Electricity - production: 179.1 billion kWh (2007 est.) country comparison to the world: 21 Electricity - consumption: 165.1 billion kWh (2007 est.) country comparison to the world: 20 Electricity - exports: 0 kWh (2008 est.) Electricity - imports: 0 kWh (2008 est.) Oil - production: 10.78 million bbl/day (2008 est.) country comparison to the world: 1 Oil - consumption: 2.38 million bbl/day (2008 est.) country comparison to the world: 9 Oil - exports: 8.728 million bbl/day (2007 est.) country comparison to the world: 1 Oil - imports: 79,250 bbl/day (2007 est.) country comparison to the world: 74 Oil - proved reserves: 266.7 billion bbl (1 January 2009 est.) country comparison to the world: 1 Natural gas - production: 80.44 billion cu m (2008 est.) country comparison to the world: 9 Natural gas - consumption: 80.44 billion cu m (2008 est.) country comparison to the world: 11 Natural gas - exports: 0 cu m (2008 est.) country comparison to the world: 125 Natural gas - imports: 0 cu m (2008 est.) country comparison to the world: 141 Natural gas - proved reserves: 7.319 trillion cu m (1 January 2009 est.) country comparison to the world: 5 Current account balance: $24.56 billion (2009 est.) country comparison to the world: 14 $132.6 billion (2008 est.) Exports: $180.5 billion (2009 est.) country comparison to the world: 20 $313.4 billion (2008 est.) Exports - commodities: petroleum and petroleum products 90% Exports - partners: US 17.2%, Japan 15.3%, South Korea 10.2%, China 9.4%, India 5.9%, Taiwan 4.6%, Singapore 4.4% (2008) Imports: $86.61 billion (2009 est.) country comparison to the world: 31 $108.3 billion (2008 est.) Imports - commodities: machinery and equipment, foodstuffs, chemicals, motor vehicles, textiles Imports - partners: US 12%, China 10.4%, Japan 7.6%, Germany 7.3%, South Korea 5.1%, Italy 4.7%, India 4.5%, UK 4% (2008) Reserves of foreign exchange and gold: $39.98 billion (31 December 2009 est.) country comparison to the world: 26 $30.59 billion (31 December 2008 est.) Debt - external: $72.45 billion (31 December 2009 est.) country comparison to the world: 40 $82.13 billion (31 December 2008 est.) Stock of direct foreign investment - at home: $149.3 billion (31 December 2009 est.) country comparison to the world: 27 $108.5 billion (31 December 2008 est.) Stock of direct foreign investment - abroad: $20.57 billion (31 December 2009 est.) country comparison to the world: 38 $18.07 billion (31 December 2008 est.) Exchange rates: Saudi riyals (SAR) per US dollar - 3.75 (2009), 3.75 (2008), 3.745 (2007), 3.745 (2006), 3.747 (2005) Back to Top Communications ::Saudi Arabia Telephones - main lines in use: 4.1 million (2008) country comparison to the world: 39 Telephones - mobile cellular: 36 million (2008) country comparison to the world: 29 Telephone system: general assessment: modern system domestic: extensive microwave radio relay, coaxial cable, and fiber-optic cable systems; mobile-cellular subscribership has been increasing rapidly international: country code - 966; landing point for the international submarine cable Fiber-Optic Link Around the Globe (FLAG) and for both the SEA-ME-WE-3 and SEA-ME-WE-4 submarine cable networks providing connectivity to Asia, Middle East, Europe, and US; microwave radio relay to Bahrain, Jordan, Kuwait, Qatar, UAE, Yemen, and Sudan; coaxial cable to Kuwait and Jordan; satellite earth stations - 5 Intelsat (3 Atlantic Ocean and 2 Indian Ocean), 1 Arabsat, and 1 Inmarsat (Indian Ocean region) (2008) Radio broadcast stations: AM 43, FM 31, shortwave 2 (1998) Television broadcast stations: 117 (1997) Internet country code: .sa Internet hosts: 471,217 (2009) country comparison to the world: 49 Internet users: 7.7 million (2008) country comparison to the world: 33 Back to Top Transportation ::Saudi Arabia Airports: 217 (2009) country comparison to the world: 27 Airports - with paved runways: total: 80 over 3,047 m: 31 2,438 to 3,047 m: 16 1,524 to 2,437 m: 27 914 to 1,523 m: 2 under 914 m: 4 (2009) Airports - with unpaved runways: total: 137 2,438 to 3,047 m: 8 1,524 to 2,437 m: 72 914 to 1,523 m: 41 under 914 m: 16 (2009) Heliports: 9 (2009) Pipelines: condensate 212 km; gas 1,880 km; liquid petroleum gas 1,183 km; oil 4,241 km; refined products 1,148 km (2009) Railways: total: 1,392 km country comparison to the world: 83 standard gauge: 1,392 km 1.435-m gauge (with branch lines and sidings) (2008) Roadways: total: 221,372 km country comparison to the world: 24 paved: 47,529 km (includes 3,891 km of expressways) unpaved: 173,843 km (2006) Merchant marine: total: 62 country comparison to the world: 64 by type: cargo 5, chemical tanker 13, container 5, passenger/cargo 8, petroleum tanker 20, refrigerated cargo 3, roll on/roll off 8 foreign-owned: 12 (Egypt 1, Greece 3, Kuwait 7, UAE 1) registered in other countries: 71 (Bahamas 16, Comoros 1, Dominica 2, France 1, Liberia 27, Marshall Islands 5, Norway 3, Panama 16) (2008) Ports and terminals: Ad Dammam, Al Jubayl, Jiddah, Yanbu al Sinaiyah Back to Top Military ::Saudi Arabia Military branches: Field info displayed for all countries in alpha order. Ministry of Defense and Aviation Forces: Royal Saudi Land Forces, Royal Saudi Naval Forces (includes Marine Forces and Special Forces), Royal Saudi Air Force (Al-Quwwat al-Jawwiya al-Malakiya as-Saudiya), Royal Saudi Air Defense Forces, Royal Saudi Strategic Rocket Forces, Saudi Arabian National Guard (SANG) Military service age and obligation: 18 years of age (est.); no conscription (2004) Manpower available for military service: males age 16-49: 8,752,167 females age 16-49: 6,680,315 (2010 est.) Manpower fit for military service: males age 16-49: 7,560,216 females age 16-49: 5,773,033 (2010 est.) Manpower reaching militarily significant age annually: male: 280,041 female: 269,580 (2010 est.) Military expenditures: 10% of GDP (2005 est.) country comparison to the world: 3 Back to Top Transnational Issues ::Saudi Arabia Disputes - international: Field info displayed for all countries in alpha order. Saudi Arabia has reinforced its concrete-filled security barrier along sections of the now fully demarcated border with Yemen to stem illegal cross-border activities; Kuwait and Saudi Arabia continue discussions on a maritime boundary with Iran; Saudi Arabia claims Egyptian-administered islands of Tiran and Sanafir Refugees and internally displaced persons: refugees (country of origin): 240,015 (Palestinian Territories) (2007) Trafficking in persons: current situation: Saudi Arabia is a destination country for workers from South and Southeast Asia who are subjected to conditions that constitute involuntary servitude including being subjected to physical and sexual abuse, non-payment of wages, confinement, and withholding of passports as a restriction on their movement; domestic workers are particularly vulnerable because some are confined to the house in which they work unable to seek help; Saudi Arabia is also a destination country for Nigerian, Yemeni, Pakistani, Afghan, Somali, Malian, and Sudanese children trafficked for forced begging and involuntary servitude as street vendors; some Nigerian women were reportedly trafficked into Saudi Arabia for commercial sexual exploitation tier rating: Tier 3 - Saudi Arabia does not fully comply with the minimum standards for the elimination of trafficking and is not making significant efforts to do so; the government continues to lack adequate anti-trafficking laws and, despite evidence of widespread trafficking abuses, did not report any criminal prosecutions, convictions, or prison sentences for trafficking crimes committed against foreign domestic workers (2008) Illicit drugs: death penalty for traffickers; improving anti-money-laundering legislation and enforcement Appendix-3: List of Hospitals in Saudi Arabia (www.araboo.com) King Faisal Specialist Hospital and Research Centre, Saudi Arabia Go One of the leading specialist hospitals and research centres in Saudi Arabia. Domain: kfshrc.edu.sa Al Hada Military Hospital, Saudi Arabia Go Military hospital in Saudi Arabia. Domain: alhada.8k.com Al Hammadi Hospital, Saudi Arabia Go A high Medical center offering distinguished medical services in all medical specialization fields. Domain: alhammadi.com Dr Noor Mohammed Khan General Hospital, Saudi Arabia Go Private hospital in Hafer al Batin, Eastern Province. Domain: drnoorkhanhospital.com King Khaled Eye Specialist Hospital, Saudi Arabia Go General information about the hospital, eye care, research, employment and contact information. Domain: kkesh.med.sa Armed Forces Hospitals Programme (AFH), Saudi Arabia Go Offers medical services to the armed forces in Southern Region of Saudi Arabia. Domain: afhsr.med.sa Saad Specialist Hospital (SSH) Saudi Arabia Go Medical center offering healthcare services in Saudi Arabia. General information, patients, professionals, contact details and more. Domain: saadmedicalservices.com King Fahd Military Medical Complex (KFMMC) Saudi Arabia Go Medical institution in Saudi Arabia specialized in offering Nephrology, transplants, vascular surgery and other medical services. Domain: kfmmc.med.sa Security Forces Hospital Program (SFH) Saudi Arabia Go Provides healthcare services mainly to employees of the Ministry of the Interior in Riyadh, Saudi Arabia. Domain: sfh.med.sa Dr. Soliman Fakeeh Hospital Saudi Arabia Go Offers information about the Dr. Soliman Fakeeh Hospital in Jeddah, Saudi Arabia. Profile, achievements, departments, services and more. Domain: drfakeehhospital.com Al Mouwasat Hospitals and Centers Saudi Arabia Go Offers medical services to internal and external customers in Saudi Arabia. Domain: mouwasat.com North West Armed Forces Hospitals Program (NWAFH) Saudi Arabia Go Offers medical services to the armed forces in North West Region of Saudi Arabia. Domain: nwafh.med.sa Adama Hospital and Clinics Saudi Arabia Go Provides information about Adama hospital and clinics in Saudi Arabia. Domain: adamaclinics.com Almana General Hospitals (AGH) Saudi Arabia Go Healthcare group offering medical services for the community in Saudi Arabia. Domain: almanahospital.com.sa Northern Area Armed Forces Hospital (NAAFH) Saudi Arabia Go Offers medical services to the armed forces in Northern Region of Saudi Arabia. Domain: kkmch.med.sa Doctor Ghassan N. Pharaon Healthcare (GNP) Saudi Arabia Go Information about the hospital in Saudi Arabia. Profile, doctors, services, contact details and more. Domain: gnp.med.sa Dr Erfan and Bagedo Hospital, Saudi Arabia Go Offers healthcare services in Saudi Arabia and the Middle East. Domain: ebhospital.com Advanced Medicine Center for Subspecialities Saudi Arabia Go Offers information about the Advanced Medicine Center for Subspecialities in Saudi Arabia. Departments, mission, members and more. Domain: amcmed.com Al Amal Complex for Mental Health Saudi Arabia Go Provides healthcare services for drug addicts, psychiatric patients, memory disorders and more. Domain: alamal.med.sa King Faisal Specialist Hospital and Research Center, Saudi Arabia Go Working in order to set healthcare standards in Jeddah, Saudi Arabia. Domain: kfshrcj.org Read More