Because large numbers of workers come from different countries with diverse economies, cultures and endemic diseases to work in Saudi Arabia, the MOH recently established a screening program for infectious and non-infectious diseases through approved health centers (AHCs) in the countries of origin of the workers. To assess this program we carried out a quality assurance survey on workers who had entered Saudi Arabia within 3 months prior to the study.
Methodology
We selected 22 companies at random from a list of companies that had requested more than 25 foreign workers in the last six months. We selected 501 newly arrived workers from these 22 companies. We obtained basic demographic information from each worker through a face-to-face interview and a review of his passport. We repeated 14 clinical and laboratory tests and defined a failure as any result in any test that would have resulted in a rejection of and individual worker during the initial AHC screening. We tested the null hypothesis that the observed failure rate was less than an acceptable failure rate (1.5%) using a Poisson distribution and calculated the 95% confidence interval (95% CI) with the Fleiss quadratic approximation.
Results
Workers (mean age = 30 years) came from six different countries: India (52%), Bangladesh (17%), Pakistan (15%), Philippines (14%), Syria (1.6%), and Thailand (0.4%). The estimated failure rate of the AHC program was 0.8%, (95% CI 0.26 - 2.2). The 0.8% failure rate was not significantly less than the 1.5% standard (p = 0.12). Only two examinations had failures. The VDRL had a 0.6% failure rate (95% CI 0.15-1.9) and the chest film for tuberculosis had a failure rate of 0.2% (95% CI 0.01-1.3). No screening failure was found for investigations regarding chronic or physiologic diseases and this 0% failure rate was less than the 1.5% standard (p < 0.01) with a 95% CI from 0% to 0.95%.
Conclusion
This new AHCS system for workers screening showed excellent quality overall for the physiologic and chronic non-infectious diseases. Although the program did not show acceptable quality for infectious disease testing, the failure was specifically due to a laboratory test for syphilis (the VDRL) known to have poor sensitivity in asymptomatic disease. In the future the known sensitivity of specific tests and the prevalence of infection in the country of origin will need to be taken into account in setting an acceptable failure rate for evaluating the AHC program.